JPOSNA® Special Edition
2022 Annual Meeting Pre-Course on Diversity, Equity, and Inclusion
Building Diverse and Inclusive Teams in Orthopaedic Surgery: Creating a Culture that Supports Diversity of Background and Thought
1Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA
Correspondence: John M. Flynn, MD, Division of Orthopaedics, Children’s Hospital of Philadelphia, 3500 Civic Center Blvd., Philadelphia, PA 19142. E-mail: [email protected]
Received: September 3, 2022; Accepted: September 12, 2022; Published: February 15, 2023
Volume 5, Number S1, February 2023
Abstract
Orthopaedic surgery has remained one of the least diverse medical specialties for decades. This reality drives our division’s targeted efforts to build more inclusive clinical and research teams. These efforts include promoting a pipeline of diverse talent through early, deliberate recruitment and prioritizing sponsorship as an advocacy tool for underrepresented backgrounds in medicine. Through this process, we have made sure to uphold curiosity and accountability. Here, we seek to describe how we have used these considerations and efforts to work towards making the orthopaedics division we inherited more representative of our patients and communities.
Key Concepts
- Building and promoting diverse and inclusive teams in orthopaedics requires intentional action from clinicians and leadership.
- Leveraging collective curiosity, early support, and sponsorship paves the way for more representative teams.
- Creating a pipeline of diverse talent early on provides us with a unique opportunity to influence the future of orthopaedics.
- As providers, we have a responsibility to create diverse, inclusive teams to not only strengthen our practice, but to ensure the best care for diverse patients.
Introduction
We must begin with two truths. First, orthopaedic surgery is one of the least diverse medical specialties. According to a 2018 census report from the American Academy of Orthopaedic Surgeons, 2.2% of all practicing orthopaedic surgeons identified as Hispanic/Latino, 1.9% as African American, and 7.6% as female.1 In 2021, the Association of American Medical Colleges reported that 20% of orthopaedic surgery faculty members were female, 2.6% were Black or African American, and 2% were Hispanic or Latino.2 Relative to the United States population, where females comprise 50.5% of the overall population, African Americans make up 13.6%, and Hispanic or Latino populations comprise 18.9%, the reality is that orthopaedic surgery as a field is not fully representative of the populations it serves.3 Second, there is substantial value in promoting and achieving diversity of thought, background, and experiences. Diverse teams foster creative, unconventional thinking and problem solving. When diversity is promoted, there is greater space for authenticity, richer discussion and decision-making, and ultimately, personal and professional growth. It has been shown that diverse teams consider situations more innovatively and diligently.4 In medicine, creating and sustaining diverse and inclusive teams also adds immense value for our patients and families. When a family sees themselves reflected in their doctors, it more easily facilitates communication and trust. And when a team is more representative of the communities it serves, the team is better able to understand the community at large.
To move beyond acknowledgment of these truths and to institute tangible changes to address them, the Children’s Hospital of Philadelphia (CHOP) Orthopaedics has taken steps to advance diverse and inclusive practices. Embracing curiosity, establishing and promoting a diverse pipeline of future stars in our field, and prioritizing the concept of sponsorship moving beyond mentorship have really helped us “walk the walk.”
Diverse individuals very likely guarantee talent. Given the structural, social, and economic barriers that many minority candidates face within academia and beyond, they likely have overcome challenges that most of us have never faced. These colleagues and candidates offer innovative and unconventional outlooks that otherwise may not be considered. Recognizing this, it becomes even more important to nurture, support, and invest in those coming from underrepresented (URM) backgrounds who demonstrate a willingness to learn as early as possible.
Unabashedly Embrace Curiosity
It takes humility to recognize and address our blind spots. As described in a recent Harvard Business Review article, growth and improvement emerge when we lean into the discomfort of confronting what we are unfamiliar with.5 When thinking about the value of curiosity in building diverse teams, a recent conversation with a pre-medical research fellow highlights the importance of asking. The student was of Venezuelan background, and our chief was interested to understand how she identified: Hispanic or Latino. She explained that because her family came from Venezuela, a country originally colonized by Spain and not a Latin American country, her family identified as Hispanic. Hispanic, however, would not be appropriate for someone of Brazilian heritage, which is of Portuguese descent. In that case, Latino would be the choice. This discussion demonstrates how embracing curiosity can be used to better understand and support diverse individuals. When we create spaces where diverse backgrounds and thoughts are sought and celebrated, it enables our URM students and colleagues to feel recognized and accepted. This validation is vital to building and sustaining diverse and inclusive teams.
It takes courage to acknowledge our cultural ignorance and to use curiosity to seek solutions. Learning from the lived experiences of URM students, faculty, and staff has the potential to broaden our perspectives and allows us to better advocate and care for those around us. Our collective curiosity can be an instigator of changing culture and ultimately, building diverse and inclusive teams.
Establish and Promote the Pipeline
Creating a diverse team does not happen overnight. It takes a great deal of dedication and intentionality to recruit, retain, and support colleagues and trainees of diverse backgrounds. In many cases, especially in a profession like medicine with a very long training journey, we must start early. CHOP Orthopaedics recently initiated the Medical Career Design (MCD) Fellowship, where seven pre-medical students were recruited to work as clinical research coordinators and medical scribes for 2 years. Our MCD Fellows, diverse in racial, ethnic diversity, and sexual orientation, assist in maintaining our division’s day-to-day research tasks while developing their own budding interests in academic medicine and clinical care. Through their hard work, curiosity, and energy, they demonstrate how recruiting diverse talent in the early stages of training can contribute to more creative and forward-looking teams.
For 15 years, the Ben Fox Fellowship has stood as another example of how starting early with diverse fellows builds a legacy of diversity in our field. The Ben Fox Fellowship, for medical students between their 3rd and 4th years, is designed to offer research, clinical exposure, and mentoring to a diverse array of medical students with an interest in pursuing an orthopaedic surgery residency program. We continue to mentor and sponsor our Ben Fox Fellows throughout their residency, fellowship programs, and beyond. Our first Ben Fox Fellow, Kristofer Jones, MD, is one of the few black orthopaedic surgeons in America and team doctor for the Los Angeles Lakers. Another of our early Ben Fox Fellows, Christine Goodbody, MD, MBE, recently returned to CHOP as a clinical fellow and was hired to grow our limb deformity and neuromuscular orthopaedics programs, comprising one of our three female orthopaedic surgeons.
This diversity pipeline continues to pay huge dividends for us and orthopaedics overall. Given that there is evidence to show that fewer minority and female medical students choose orthopaedics relative to other surgical specialties, it is fair to assume that we have a steep hill to climb before we can achieve truly representative teams.6 Through programs encouraging pre-medical and medical students to both gain exposure to orthopaedics and envision themselves within the field, then supporting them along the way, we are adding to the pipeline that will improve our field in the future.
Prioritize Sponsorship
We all have achieved great things in large part due to the advice, support, and guidance of our mentors. The value of a good mentor is indisputable. However, when looking to build strong, diverse teams, we must focus on establishing sponsorships. Sponsorship originates when a meaningful mentorship has evolved to a point where the mentor is personally invested in the success and development of their mentee. This devoted commitment transforms them into a sponsor. A sponsor advocates by putting their own name and reputation on the line. In this way, sponsorship extends well beyond mentorship. As we work to build the pipeline of diversely talented individuals within our team, our leadership team has sought to prioritize sponsorship. Because our team works so closely with a range of trainees, from medical students to residents to clinical fellows, there are plenty of opportunities to practice this form of advocacy.
Walk the Walk
It’s easy to talk a big game about why diversity and inclusion in teams are important. Recognizing a need for more diverse and inclusive teams in orthopaedic practice is one thing, but going the extra mile to intentionally implement changes to achieve this goal is not so easy. Through CHOP Orthopaedics’ pipeline of student programming, our sponsorship endeavors, and our concerted effort to increase diverse and inclusive practices, we are determined to walk the walk, not just talk the talk. We have discussed some methods and mindsets that we feel are most useful in building and sustaining diverse teams. However, in order to cement a legacy that is better than before, a major piece of the puzzle is accountability. When promising diverse and inclusive practices, it is easy to leave them at just that: promises. However, by assigning tangible goals, measures, and metrics to evaluate our efforts, it becomes much easier to hold ourselves and each other accountable.
Build a Legacy
The field of orthopaedic surgery that we inherited is not our fault. Similarly, there is nothing we can change about how orthopaedics was structured in the past. However, we have the power to make orthopaedic surgery a stronger, more representative field today. We recognize that our work in creating a more inclusive and representative field of orthopaedics is no easy feat. It requires curiosity, open-mindedness, and a willingness and commitment to improve. CHOP Orthopaedics is proud to include a diverse range of backgrounds and identities, spanning different races, ethnicities, religious backgrounds, political affiliations, genders, sexualities, and life experiences. As the adage goes, “You can’t be what you can’t see.” We have a responsibility to intentionally recruit, promote, and make visible students and colleagues who bring diverse thoughts and backgrounds to our practice. Doing so will ideally attract diverse students and colleagues and ultimately, strengthen our field as a whole.
Disclaimer
The authors have no conflicts of interest to report.
References
- Orthopaedic Practice in the U.S. 2018 AAOS Department of Clinical Quality and Value.; 2017. Available at: https://www.aaos.org/globalassets/quality-and-practice-resources/census/2018-census.pdf.
- U.S. Medical School Faculty by Gender, Race/Ethnicity, Degree, and Department, 2021. Association of American Medical Colleges. Available at: https://www.aamc.org/media/9756/download?attachment. Accessed July 15, 2022.
- U.S. Census Bureau QuickFacts: United States. www.census.gov. Available at: https://www.census.gov/quickfacts/fact/table/US/LFE046220.
- Phillips KW. How diversity makes us smarter. Sci Am. 2014;311(4):42–47.
- Dukach D. DEI Gets Real. Harvard Business Review. Published January 1, 2022. Available at: https://hbr.org/2022/01/dei-gets-real.
- Day C, Lage D, Ahn C. Diversity based on race, ethnicity, and sex between academic orthopaedic surgery and other specialties. J Bone Joint Surg. 2010;92(13):2328-2335.