WHAT'S INSIDE

Diversity Initiative for SNACC

Linda S. Aglio, MD, MS
M. Angele Theard, MD

Linda S. Aglio, MD, MS
Linda S. Aglio, MD, MS
M. Angele Theard, MD
M. Angele Theard, MD

“If everyone is thinking alike, then no one is thinking” – Benjamin Franklin’s early reference to diversity is still relevant today.1 Differences in ethnicity, age, gender, sexual orientation, and social, political or religious beliefs are meant to be embraced and celebrated in a climate of equality. Diversity of thought, achieved through a diverse populace, is essential for assuring that organizations like SNACC continue to promote an environment which encourages innovation necessary for achieving its mission: to advance the art and science of the care of the neurologically impaired patient. This 43-year-old organization was given breath by a small group of like-minded neurosurgeons and neuroanesthesiologists.  Bylaws governing membership acknowledge that “maximum benefit in patient care will require an open membership policy” and serve as the foundation for membership in this international organization of scientists.2

From time to time, however, we members of SNACC must re-evaluate our organization, its history and future to be sure that we continue to support an international and diverse membership and that our organization reflects  the increasingly diverse population in our specialties. Current percentages of 12% African-American population, 18% Hispanic or Latino population, and 6% Asian population are expected to increase.3

As a result of the fall of the Soviet Union, the recent Syrian conflict and the European Union (EU), diversity has expanded with 1.3 million immigrants applying for asylum in the 28 EU countries in 2015, doubling previous years’ numbers. Unfortunately, race-conscious policies and programs useful for increasing the numbers of Black, Latino, and Native American physicians, who likely can empathize better with the underserved, have been scrutinized as unnecessary and racially biased.4-7 This critique undoubtedly is contributing to the slowing growth in recent years of a diverse medical physician force: 61% of medical school faculty are white, 13% Asian, 4% Hispanic, and 2.9% Black or African-American and are teaching 57% white, 20% Asian, 8% Hispanic, 6% African-Americans, 1% foreign, and 0.2% American Indian medical matriculants.8 Furthermore, promotion eludes a majority of these faculty of color. Women have made great strides becoming almost equal in medical student numbers to men. However, after joining the faculties of any number of academic medical centers, they are promoted less often than men and significantly more men reach full professor than women in each ethnic category.

The benefits of a diverse workforce are well documented: academic and social growth at the university level; more favorable attitudes toward underserved populations and greater interest in serving them; more ground breaking research; and financial institutions outperforming those whose constituency is more homogeneous.9-12 As SNACC’s membership continues to increase, we have the opportunity to welcome a more diverse population of enthusiastic educators, scientists, students and future leaders in an organization which empowers its members to think critically in a supportive environment. In this way, our forward-thinking, international organization would be even better positioned to unravel the questions that persist in neurological disease, as well as to serve as a model for the myriad other organizations in our medical community.

By 2065, projections show that new immigrants and their descendants will drive U.S. population growth and, among the estimated 441 million Americans, 78 million will be immigrants and 81 million will be people born in the U.S. to immigrant parents.13 It is, in part, from this pool of people that we will meet our patients as well as potential colleagues with whom we will collaborate in scientific innovation, clinical care, new educational strategies and leadership in a host of medical organizations. Are we, at SNACC, prepared to welcome an increasingly diverse group of colleagues with new and innovative ideas, professionally collaborate with them, respectfully consider their ideas and reward them with leadership opportunities in their respective institutions as well as in SNACC?

Diversity in an organization requires an understanding and appreciation of its members. Mentoring experiences of underrepresented faculty of color were examined at the University of Maryland. One of the themes identified was that connecting with mentors who understand the difficulties specific to under-represented groups at predominantly white institutions can help faculty of color succeed there.14 This understanding or cultural competency is defined as awareness of unique and defining characteristics of a population, i.e., belief systems, family structure, historical realities, cultural biases and how these different patient profiles influence the way individuals experience illness, understand medical therapy and end of life issues.8,15-16 In research, cultural competency plays a key role in study design, development of research questions and hypotheses, recruitment, consent, interpretation of research findings, and conclusions. Many researchers have not been trained to work from and/or incorporate the perspective of under-represented groups into their work, therefore tending to assume the cultural perspective of the “majority” in the conduct of their work. Cultural competency that provides some benefit in improving care is becoming an important consideration for conducting community-based research in a diverse patient population; this educational construct may be important for encouraging supportive relationships among fellow physicians in practice groups, academic institutions, and medical societies. Cultural competency provides a sound basis upon which to promote a program for diversity in SNACC in order to provide a more inclusive environment for all our members, at the same time broadening our abilities to help our patients. In an effort to stay relevant as an organization serving neurologically impaired patients everywhere, we would like to ensure that our organization supports diversity of thought and provides an inclusive and supportive environment for everyone. 

We invite the Board of Directors to consider the following definition of diversity and training, a provisional mission statement for our group and some possible action items. We invite SNACC members who have a special interest in sharing and contributing their thoughts and expertise regarding diversity to participate in this initiative.

Diversity training involves the intent of looking at the diversity in an organization in order to impact a more inclusive environment for all members.

Mission Statement

The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) is an independent, nonprofit organization dedicated to the neurologically impaired patient. This organization acknowledges and honors the fundamental value and dignity of all individuals. SNACC members are committed to individual and organizational efforts to welcome a diverse group of scientists and practitioners and safeguard fairness, equality, and respect.

Diversity means more than just acknowledging and or tolerating difference. Diversity is a set of conscious practices that include:

  • Understanding and appreciating interdependence of humanity and cultures
  • Practicing mutual respect for qualities and experiences that are different from our own
  • Understanding that diversity includes not only ways of being but ways of knowing
  • Recognizing that discrimination creates and sustains privileges for some while creating and sustaining disadvantages for others
  • Building alliances across differences so that we can work together to eliminate all forms of discrimination

Potential Action Items

  1. Survey to all SNACC members to:
    1. Identify underrepresented members
    2. Identify members who are interested in leadership roles
  2. Establish a Diversity Committee as a subcommittee of the Board of Directors
    1. Emphasize the importance with a long-term commitment
    2. Additionally, establish an affinity group: A place within an organization for like-minded people to network and share their experiences. These groups are used to demonstrate their commitment to diversity and inclusion. They promote recruitment and retention. They assist in creating a welcoming environment and help to understand the issues these groups face and how to help address them.
  3. Website
    1. Dedicated space for diversity-driven activities
  4. Establish two Diversity Travel Awards to promote entry level membership
    1. Resident eligible
    2. Medical student eligible
  5. Establish a Diversity Mentorship program
    1. Identify mentors for career guidance, academic and research endeavors
    2. Identify interested members of diversity at large

References:

  1. Benjamin Franklin (1706-1790), quote from. http://www.quotes.net/quote/66261
  2. Abin MS, The Genesis of a Neuroanesthesiology Society NAS-SNANSC-SNACC. Journal of Neurosurgical Anesthesiology. 1997;9(4):296-307
  3. http://www.pewresearch.org/fact-tank/2015/10/05/future-immigration-will-change-the-face-of-america-by-2065/
  4. Grutter v Bolliinger, 539 US 306 (2003)
  5. Gratz v Bollinger, 539 US 244 (2003)
  6. Slevin P. Affirmative action foes push ballot initiatives: activists with eyes on November, focus on five states. Washington Post. 2008, A02
  7. Castillo-Page, L Facts and Figures, 2012, AAMC, Diversity Policy and Programs, 2012 https://members.aamc.org/eweb/upload/Diversity%20in%20Medical%20
    Education%20Facts%20and%20Figures%202012.pdf
  8. Cohen, JJ The consequences of premature abandonment of affirmative action in medical school admissions. JAMA.2003;289:1143-49
  9. Gurin P, Dey EL, Hurtado S, Gurin G. Diversity and Higher Education: Theory and Impact on Educational Outcomes. Harvard Educational Review, 2002;72(3):330-366
  10. Elam CL, Johnson MMS, Wiggs JS, Messmer JM, Brown PI, Hinkley R. Diversity in medical school: perceptions of first year students at four southeastern US medical schools. Acad Med. 2001;76(1):60-65
  11. Saha S, Guiton G, Wimmers PF, Wilkerson L, Student body racial and ethnic composition and diversity-related outcomes in US Medical Schools. JAMA. 2008; 300(10):1135-45
  12. Ko M, Heslin KC, Edelstein RA, Gumbach K, The role of medical education in reducing health care disparities: the first ten years of the UCLA/Drew medical education program. JGIM, 2007;22 :625-31
  13. http://www.pewresearch.org/fact-tank/2015/10/05/future-immigration-will-change-the-face-of-america-by-2065/
  14. Zambrana RE, Ray R, Espino MM, Castro C, Cohen BD, Eliason J. “Don’t leave us behind”: The importance of mentoring for underrepresented minority faculty. American Educational Res Jour.2015;52(1):40-72
  15. https://catalyst.harvard.edu/pdf/diversity/CCR-annotated-bibliography-10-12-10ver2-FINAL.pdf Cultural Competence in Research, The Harvard clinical and translational science center, annotated bibliography, 2010:1-55
  16. O’brien RL, Kosoko-Lasaki O, Cook CT, Kissell J, Williams PF, Self-assessment of cultural attitudes and competence of clinical investigators to enhance recruitment and participation of minority populations in research. Journal of National Medical Association, 98(5);674-682
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