Brought to you by the EAST Manuscript and Literature Review Committee
This issue was prepared by EAST Equity, Diversity, and Inclusion in Trauma Surgery Practice Committee Members Kelly Galey, MD and Christine Castater, MD, MBA.
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The systems which have created inequities within the medical community, and in our society, are multifaceted and self-reinforcing. Recommendations for improvements are difficult to implement and hard to measure. This paper describes the impressive and concrete actions by the Pediatric Residency Program at the University of California, San Francisco, to address the underrepresentation of Black, Latinx, American Indian, and Alaska Native communities within their residency program.
Their aims were “to increase the recruitment of UIM(Underrepresented in Medicine) physicians, foster a community that allows UIM physicians to thrive, and train physicians to provide quality care for diverse patient populations.” After performing a survey of residents’ perceptions in 2016, they presented their findings to leadership of the residency program and Department of Pediatrics to establish institutional commitment. They formed a leadership core as well as seven subcommittees: recruitment, curriculum, social, community partnership, advocacy, liaison and alliance, and media.
Notably, over the six years reported, they obtained funding, two faculty roles w 10%FTE each, a recognized Chief Resident role, inclusion on the ranking advisory committee, began a DEI and antiracism curriculum, developed opportunities to recruit, retain and support UIM residents, and partnered with a local organization to host educational webinars for underrepresented high school students. There was a notable increase in the number of UIM residents over the study period.
Their informed and multi-pronged approach to identifying and addressing underrepresentation within their program and the field is inspiring and could serve as a general blueprint for other departments to address similar disparities.
Trauma patients face significant difficulties impacting the ability to recover from their injuries. Financial hardship related to the loss of work, possible loss of housing, and medical bills compounded by debilitation and/or mental health factors, such as post-traumatic stress disorder, further impede recovery. While there is extensive evidence that outcomes for trauma patients from historically marginalized communities are worse, it is less clear how to intervene.
This study enrolled eighty patients, from January 2022-November 2023, treated for traumatic injuries or burns, at two Level I trauma hospitals within Mass General Brigham. Patients were Spanish speaking with limited English proficiency(LEP). This study was part of a quality improvement project funded to address “an inequity or disparity within the field.” The authors used information from their multi-institutional FORTE(Functional Outcomes and Recovery after Trauma Emergencies) database, as well as stakeholder interviews, to identify barriers impacting post-injury recovery in this group. Informed by this data they developed the Non-English Speaking Trauma Survivors(NESTS) pathway which was initiated by a community health worker (CHW). The CHW speaks Spanish as her first language, is a certified medical interpreter, with psychiatry training, and has experience with available community resources and the local Spanish-speaking population. Consent was obtained by the CHW who then provided an educational pamphlet containing community resources and showed a 5-minute video describing the services offered by the pathway. An intake survey identified patients as either high or low risk for mental health and social needs, which resources should be prioritized, and created a “composite social vulnerability score.” Patients were provided with Jeenie, an app that provides on-demand interpreter services whenever needed. A discharge plan which included the resources needed was created and monitored by the CHW who could provide increased assistance based on a patient’s identified need and their ability to utilize the resource.
A mental health, financial or social services post-discharge need was identified in 60/80 of the enrolled patients (75%), and of these 48/60 (80%) were able to be connected to a resource. Reported need was most commonly food support, transportation, and utilities (57.5%, 41.3% and 37.5% of 80 enrolled patients, respectively). A post-discharge survey of a subset of patients demonstrated high utilization of resources: 16/25 patients were actively using the resources and 5/25 had pending appointments to establish services. The authors also highlight that historically in the FORTE database at 6-12 months after traumatic injury, Spanish-speaking patients are receiving mental health treatment 10% of the time compared to 36% for English-speaking patients. In patients on the NESTS pathway this was increased to 20%.
This study demonstrates that measurable improvement can be obtained with thoughtful evaluation of outcomes and the systems that drive them. In this important work, it is notable that the group worked with their specific strengths and barriers. While some of their success hinged on a singularly qualified individual for their project, trauma providers should evaluate their own center’s disparities in outcomes, and identify mechanisms to intervene, with their own specific strengths, resources, and personnel.
Diversity, Equity, and Inclusion (DEI) programs have become increasingly prevalent in academic health institutions over the past decade. These initiatives aim to address the historical exclusion of underrepresented groups and promote a more inclusive environment for students, faculty, and staff. The article "The Evolving Role of Diversity, Equity, and Inclusion Programs in Academic Health Institutions" explores how these programs have developed and adapted to meet the changing needs of diverse populations.
The authors highlight the initial aspirations of DEI programs, which sought to create diverse academic communities that better reflect society. They acknowledge that while these programs have made significant strides, they are now facing new challenges, such as legal restrictions following the Supreme Court's ruling on affirmative action and growing polarization on university campuses. These challenges have led to a re-evaluation of DEI efforts, emphasizing the need for flexibility and adaptation because underrepresented groups continue to require representation.
Despite increasing challenges, the article underscores the essential role of DEI programs in fostering inclusive academic environments. The authors advocate for expanding the focus of these programs beyond race and ethnicity to include a wider range of identities and experiences. A renewed commitment to DEI is needed because academic institutions must ensure justice for the diverse populations they educate.
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This Literature Review is being brought to you by the EAST Manuscript and Literature Review Committee. Have a suggestion for a review or an additional comment on articles reviewed? Please email litreview@east.org. Previous issues available on the EAST website.
