University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
Am J Surg. 2021 May;221(5):950-955. doi: 10.1016/j.amjsurg.2020.08.051. Epub 2020 Sep 6.
Academic health centers have promoted initiatives to improve diversity, equity and inclusion in medicine. Despite this emphasis, there has been limited discussion on practical strategies for navigating bias within academic surgery. This study analyzes experiences of confronting bias within the department of surgery at the University of Michigan.
We conducted telephone interviews (n = 15) from January 2019 to January 2020 with surgeon volunteers at one academic institution. Two investigators conducted interviews following a semi-structured guide based on personal experiences with bias between healthcare workers with diverse identities. Interviews were conducted concurrently with thematic coding, coded independently by two investigators, and discussed until consensus was reached. Analysis proceeded following the inductive and comparative approach of interpretive description.
The most common incidents of bias were based on gender and race. They occurred along numerous relationship axes, including physician-patient and resident-faculty. A critical factor in bias response was unambiguously recognizing bias. Responding to bias consists of timing and nature of the response, defined as when the subject responded relative to the incident and the actions done in response to the incident respectively. Barriers to bias response were fear of retribution and extensive energy required to respond. Institutional culture was important, specifically in representation and support from peers and administration.
This study probes deeper into equity and inclusivity in the academic field of surgery, offering insight into common barriers to confronting bias. Overall, these findings offer a basic framework for allies to identify bias and to partner with colleagues to address biases in a supportive manner.
学术医疗中心已经提出了多项倡议，以改善医学领域的多样性、公平性和包容性。尽管有此重视，但在探讨如何解决学术外科领域内的偏见问题方面，讨论仍然有限。本研究分析了密歇根大学外科系内部应对偏见的经验。
我们于 2019 年 1 月至 2020 年 1 月期间，对一家学术机构的外科医生志愿者进行了电话访谈（n=15）。两位研究者根据医疗保健工作者在不同身份之间的偏见的个人经验，使用半结构化指南进行访谈。访谈同时进行主题编码，由两位研究者独立进行编码，并进行讨论直至达成共识。分析遵循解释性描述的归纳和比较方法进行。
最常见的偏见事件基于性别和种族。它们发生在许多关系轴上，包括医生-患者和住院医师-教员。偏见应对的一个关键因素是明确识别偏见。应对偏见包括响应的时机和性质，分别定义为相对于事件的响应时间和针对事件采取的行动。应对偏见的障碍是报复的恐惧和应对偏见所需的大量精力。机构文化很重要，特别是在同行和管理层的代表性和支持方面。
本研究深入探讨了外科学术领域的公平性和包容性，深入了解了应对偏见的常见障碍。总的来说，这些发现为盟友提供了一个基本框架，以识别偏见，并以支持性的方式与同事合作解决偏见问题。
