Reframing Surgery Using the Concepts of Diversity,Equity,and Inclusion

We all have different cultures, languages, backgrounds, orientations, nationalities, strengths, and weaknesses, but the one thing that we have in common is that we all are humans. We are social animals but to be human is to be inclusive and equitable. Respecting and accepting diversity are essential to our humanity and our world.

In this cutthroat world, it’s difficult to be conscientious. There are so many factors that make the above-mentioned qualities quite a challenge. Numerous initiatives are carried out in almost every field to promote diversity, inclusion, and equity (DEI). Specific to health care, a very well-written paper by Lingras et al details a 6-step model to monitor DEI in an organization as mentioned below. ¹

1. Leadership: practice what is preached, the alignment of formal and informal behaviors.

2. Membership: open invitation to inclusive and dedicated members.

3. Guidelines: Focus on active listening, respect for silence and confidentiality.

4. Goals: Short term (add DEI values/efforts to department motto) and long term (didactics, grand rounds, and reflective opportunities).

5. Communication: Collaboration of multidisciplinary departments.

6. Evaluation: Qualitative and quantitative approaches to assess the response of each step at the individual, department, committee, and institutional levels.

One critical but often overlooked component of health care is medical trainees. I would like to share a story to show how DEI played a crucial role in the success of one resident. Once there was a boy from a rural area of Pakistan who dreamt of becoming a doctor. He worked hard to get into the top medical school in Pakistan and took advantage of an opportunity for an away rotation in the USA. During this rotation, he realized that he wanted to be trained in the USA. However, many of his peers discouraged him from pursuing his dream of becoming an American Board-Certified Surgeon because they said it would be too difficult. Despite this, he worked hard and matched in a preliminary position for two consecutive years. His visa situation did not allow him to go through the normal match cycle again, so he had three options: change to a non-surgical specialty, find an out-of-cycle categorical position, or go back home to Pakistan. He wanted badly to be a surgeon and just as badly to stay in the USA, so he chose the toughest option with the most risk. His application for out-of-cycle positions did not yield results until May of 2019 when he was offered a categorical position as a PGY-3 in rural Pennsylvania. Four years later, he became a double board-certified surgeon.

This is my story, but this is also the story of many foreign medical graduates (FMGs) on visas who work hard to become surgeons in the USA. Everyone may think that it was my determination, scores, hard work, fortune, or other factors that led to my success. While these things played a role, I firmly believe that DEI on all levels helped me the most. I was fortunate to be in places where most people did not see me as a foreigner. My ethnicity did not matter, my first language did not matter, and my background did not matter. What mattered was who I was as a person and the character of those around me. The support that I received made me succeed in this tough specialty. The leadership at all of my programs was supportive and they had a clear goal of making me a surgeon. At work, I was an important pillar of every team clinical or non-clinical, while outside the work, the same colleagues helped me settle in this country to the extent they taught me how to drive and helped me even relocate to a different state. These life experiences at work and outside the work created a sense of belonging for me in this country. This example is at an individual level, but DEI also helps a system succeed on the institutional level.

Big places don’t get big because of research, money, or stakeholders. Success comes when the leaders, employees, and staff practice a culture of development. For example, Microsoft in 2024 became the most valuable company in the world not only due to AI, cloud service, etc. Rather, they cultivated a growth mindset and culture of development of which DEI is a fundamental component. When the current CEO of Microsoft was hired in 2014, it was not the most valuable company. He reframed the know-it-all ideology to a “learn-it-all” curiosity which in turn inspired employees, developers, investors, and customers to engage with the company in new and innovative ways. In other words, Microsoft became inclusive and diverse, thus giving equal opportunity to everyone to pitch in. As a result, the company went up in value.^2-4

If I analyze Microsoft based on Lingras’ model, it shows that leadership changed the ideology to all-inclusive, collaborated with numerous developers, allowed employees to experiment and make mistakes and learn from them, and had short-term goals of sharing values and ideas but long-term goals of giving Microsoft its crown back. This is how DEI manifests success.

In health care, successful hospital systems have employees from diverse groups, but they also value diversity of ideas. These hospitals have trained, hired, and retained those individuals not because of monetary benefits but because they foster a culture of making their employees feel valued and listening to their employees’ opinions. Admittedly, not all hospitals with DEI committees have been able to retain talent or succeed financially. I think there are multiple ways on an organizational level to solve these issues, one of them being the Lingras 6-step model.

I would conclude by saying that if we cultivate an atmosphere wherein diversity, equity, and inclusion are valued and celebrated, we will make ourselves, our organizations, and our systems better and stronger and will create a sense of belonging for each other.