Diversity, Equity, and Inclusion Feature: Fixing the Leaky Pipeline to Careers in Surgery: A Longitudinal Mentoring Program for High School Students

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Fixing the Leaky Pipeline to Careers in Surgery: A Longitudinal Mentoring Program for High School Students

While racial diversity in medical student applicants, matriculants and graduates has increased over time, underrepresentation of historically excluded groups continues on the basis of race/ethnicity in general surgery residency training programs.^1,2 The efforts to increase matriculant diversity require an understanding of the perceptions, experiences, and impediments of those in underrepresented groups much earlier in the process. From public school funding and resources to college preparation, students’ educational experiences vary widely based on race/ethnicity.³ Studies have shown that supplemental pipeline programs that provide scientific education, career exposure and mentoring are successful in achieving professional development and in encouraging students to apply to surgical subspecialities.^4,5 Although programs have shown progress, there are many mentees lost along the pipeline necessitating improvement.

With this in mind, the American Association for the Surgery of Trauma (AAST) Diversity, Equity and Inclusion (DEI) Committee hit the ground running. Through hard work, dedication and multiple revisions, the committee, under the leadership of Dr. Karen Brasel, was awarded one of the inaugural American College of Surgeons (ACS) Innovative Diversity, Equity and Inclusion Regental Grants in conjunction with the ACS Committee on Trauma and the Pediatric Trauma Society (PTS) to create a longitudinal pipeline program.

Dr. Cherisse Berry, as the newly installed chair of the AAST DEI Committee in 2021, was charged with carrying this program through along with many other visions. Her first order of business was to create five subcommittees; Outreach led by Dr. Sharon Henry, Communication and Advocacy led by Dr. Brandon Bruns, Communication and Education led by Dr. Fariha Sheikh, Mentorship led by Dr. Anne Mosenthal and Research led by Dr. Heather Hoops. This report will focus on the work of the Outreach Subcommittee.  The initial objectives of the subcommittee were to identify a vice chair and to create a mission statement.  “The mission of the Outreach Subcommittee of the American Association for the Surgery of Trauma Diversity, Equity and Inclusion Committee is to improve the delivery of equitable care to emergency surgical and injured patients through the implementation and support of programs and strategies to increase the presence of underrepresented minorities who have been historically, systematically excluded from healthcare careers. We aim to increase opportunities for leadership in healthcare generally and specifically within the Acute Care Surgery community instilling hope, preparedness and opportunity for the next generation of leaders.”

Dr. Bethany Strong stepped up and into the Vice Chair role for the Outreach Subcommittee. The charge of this subcommittee is threefold:

1. Actualize the ACS Innovative Diversity, Equity and Inclusion Grant
2. Collaborate with DEI committees of other organizations to advance the mission of DEI within Trauma and Acute Care Surgery including the ACS Committee on Trauma (COT) and the Eastern Association for the Surgery of Trauma (EAST) for all
3. Lastly, to seek internal and external grants/funds and donations to help advance the initiatives developed by the subcommittee.

Our most pressing order of business was to transform the ACS grant from a concept to a program.  The $25,000 grant with matching funds from the AAST and PTS provides $50,000 to create a pipeline program involving middle and high school students from underrepresented groups.  The program is unique in that it offers the student a mentor that will provide longitudinal support through their graduation from high school.  By providing continuous support, we hope to increase the likelihood of success.  The goal is to pair students from the city in which the annual meeting will be held with mentors affiliated with the AAST, ACS or PTS who are also located in that city.  Continuing a multi-year mentor-mentee relationship will be logistically easier to manage with mentor-mentee pairs (MMPs) co-located.  Should circumstances arise that make it necessary, mentors from cities other than the host can be entertained.  Given the ease of video conferencing and chatting, developing the relationship between the MMPs will still be possible in virtual settings.  We will fund activities throughout the year that will include membership to the International Surgical Science Museum, funding for a Scholastic Aptitude Test (SAT) preparatory course and a grab bag of various tokens.  The highlight of the year will be the workshop to be held at the AAST, ACS and PTS annual meetings in 2022.  Each workshop will be planned by the DEI committee of the organization.

The AAST workshop will be held on September 23, 2022, from 9 am until 4: 30 pm.  Ten students with an interest in healthcare careers have been chosen from a robust outreach program for underrepresented high school students run by Dr. Abdullah Pratt affiliated with the University of Chicago called Medical Careers Exposure and Emergency Preparedness Program (MedCEEP).  The students will be shuttled from the University of Chicago Medical campus to the conference hotel on the day of the event.  The day will begin with welcome, introductions and an ice breaker activity.  The next segment will focus on leadership through speed networking-style brief topical interactions with volunteers that will include medical students, residents, AAST members, nurses, nurse practitioners, technicians, therapists and paramedics. 

The morning events will conclude with an exercise to emphasize the importance of research and how to ask and answer a research question.  The students will work in groups with facilitators to develop a research question from their community and develop a strategy to answer the question. They will then have an opportunity to meet with their AAST assigned mentor during lunch.  In the afternoon, they will work directly with vendors that are donating materials and their time to give the students an idea of the tools we use to take care of patients and the innovation required to develop them. The students will then compete in performance of various skills such as wound packing, tourniquet placement and suturing.  Lastly, we will introduce the students to the AAST membership and present their certificates during the business meeting.  Our goal is to make this workshop a part of our annual meeting going forward.  A special thank you to the vendors that have so far agreed to participate in the workshop.  They include Avita Medical, Prytime Medical^TM devices, Acumed and Integra LifeSciences.

Providing support and encouragement to students from underrepresented backgrounds can improve diversity in healthcare. As we know, “talent is universal, opportunity is not.”

References

1. Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019. 2019:3-5.
2. Abelson J, Symer M, Yeo H, et al. Surgical time out: Our counts are still short on racial diversity in academic surgery. Am J Surg 2018; 215:542-548
3. Weir, Kirsten. Inequality at school: What’s behind the racial disparity in our education system? American Psychological Association. 2016; 47(10);42. Available at https://www.apa.org/monitor/

2016/11/cover-inequality-school. Accessed August 10, 2020.

4. Kana LA, Noronha C, Diamond S, et al. Experiential-Learning Opportunities Enhance Engagement in Pipeline Program: A Qualitative Study of the Doctors of Tomorrow Summer Internship Program. J Natl Med Assoc. 2020 Feb;112(1):15-23.

5. Mason BS, Ross W, Ortega G, Chambers M, Parks M. Can a Strategic Pipeline Initiative Increase the Number of Women and Underrepresented Minorities in Orthopaedic Surgery? Clin Orthop Relat Res. 2016 Sep;474(9):1979-85.