American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

The Communication Pulse: Leadership and Member Perspectives

100 Words

The sharps document outlines safety measures that we should all embrace. A few years ago, one of my partners casually leaned on a Mayo stand during surgery and his ulnar nerve was transected by a knife blade that had been placed there by a member of the surgical team. How would you react to this career-altering accident? Such calamities are completely avoidable with proper communication between OR personnel. I insist that scalpels are passed using a kidney basin to "hold" the scalpel. I often say: "knife down," making all that are scrubbed aware of where this tool is located.

L. Scott Levin, MD, FACS, Chair, American College of Surgeons (ACS) Board of Regents

Surgeon Voices

From the Frontlines

In this issue, Steven D. Wexner, MD, FACS, FRCSEng, FRCSEd, FRCSI(Hon), FRCSGlasg(Hon), Vice-Chair, American College of Surgeons Board of Regents, and Director, Digestive Disease Institute at Cleveland Clinic Florida in Weston, FL, interviews:

Ajita S. Prabhu, MD, FACS, who discusses her research on robotic inguinal hernia repair, which data indicates may have challenges compared with laparoscopic hernia repair.



Carla M. Pugh, MD, PhD, FACS, who discusses the intersection of surgical simulation and skills assessment.



Diversity, Equity and Inclusion in Surgery

Joshua M. Mammen, MD, PhD, FACS, interviews Brett M. Tracy, MD, coauthor of the ACS Bulletin article, "Glass ceilings and sticky floors: Examining diversity and inclusion in the surgical workforce."



Practice Protection Committee

Patrick V. Bailey, MD, MLS, FACS, Medical Director, Advocacy, ACS Division of Advocacy and Health Policy, interviews Mark Savarise, MD, MBA, FACS, and Charles D. Mabry, MD, FACS, on improving your reimbursement beyond coding.



Honoring Black Surgeons and Fellows: Spotlight on Dr. LaSalle D. Leffall, Jr., First Black ACS President

Dr. LeffallIn recognition of Black History Month and in honor of the many Black surgeons who have made history in the U.S., the Bulletin Brief will present weekly profiles of Black Fellows who helped turn the ACS into the world-class surgical organization that it is today. This week, the ACS honors LaSalle D. Leffall, Jr., MD, FACS, the first Black President of the ACS.

Dr. Leffall had a long and eminent career as a surgical oncologist and medical educator, serving as Howard University's chairman of the department of surgery for 25 years. Dr. Leffall was dedicated to addressing health care disparities in cancer patients, specifically among Black Americans—a goal ahead of its time, and which has grown in importance and focus as modern health care has started to reckon with racial bias.

Dr. Leffall was elected 1995–1996 ACS President. In addition, he was the first Black President of the American Cancer Society, the Society of Surgical Oncology, the Society of Surgical Chairs, and several other professional organizations. Dr. Leffall died on May 25, 2019, leaving behind a legacy of service and compassion. Read an article in remembrance of Dr. Leffall's life and career in the Bulletin of the American College of Surgeons.

For his many contributions to surgery and the College, Dr. Leffall was named an ACS Icon in Surgery in 2019. View Dr. Leffall's Icons in Surgery video.

Examining Diversity and Equity in the Surgical Workforce

January 2021 Bulletin coverThis week—as the Bulletin Brief continues to highlight diversity, equity and inclusion-centered articles from the January issue of the ACS Bulletin—the focus is on DEI in the surgical workforce. In "Glass ceilings and sticky floors: Examining diversity and inclusion in the surgical workforce," the authors, members of the Resident and Associate Society of the ACS, identify historical milestones in achieving a level of diversity in health care, describe the lack of racial and ethnic representation in the medical profession, and summarize the attitudes and perceptions of sexual orientation in the surgical workforce.

The article begins as follows:

Glass ceilings and sticky floors: Examining diversity and inclusion in the surgical workforce

by Brett M. Tracy, MD; Kevin Koo, MD, MPH, MPHIL; Bethany Strong, MD, MS; Michael Poulson, MD; Katie M. Marsh, MD; Randi Ryan, MD; and Julia R. Coleman, MD, MPH

Diversity has been defined as a condition of having or being composed of differing elements. In several sectors of the modern workforce, diversity is recognized as a fundamental factor for success and innovation. However, the health care industry lags in diverse representation, which precludes the delivery of culturally competent and sensitive care. Specifically, surgical specialties have a significantly lower demonstration of diversity in the workforce than nonsurgical specialties in terms of gender, prior work experience, political identity, and sexual identity.

Recognizing these deficiencies, the Institute of Medicine (IOM, now known as the National Academy of Medicine) charged the medical community with diversifying as a compelling interest of the nation.3 In 2004, the IOM suggested that a more diverse health care workforce would improve access to care for minority populations, facilitate communication, and promote greater shared decision making between patients and clinicians. Furthermore, diverse representation could lead to more comprehensive surgical education, as well as innovations in translational research.

Although recruiting from and promoting inclusion of different demographic pools seems simple, it can be challenging because of what is known as the Dunning-Kruger Effect. This cognitive bias is a type of anosognosia that leads an individual to make an illusory, superior self-assessment. For example, a white, heteronormative male who lacks an appreciation or awareness of the importance of diversity fails to acknowledge this deficit, then incorrectly claims to be culturally dexterous. Such a cognitive bias ultimately risks perpetuation of the lack of diversity in the surgical workforce.

French and colleagues examined the surgeon's perception of diversity in the workplace, and four common themes emerged: personal experiences based on religion, marital status, political identity, number of children, geographic origin, race, and so on; professional experiences, such as undergraduate major, employment history, military service, age, and so on; personal health; and gender or sexual identity.2 These categories highlight the extensive metrics of diversity, but only a few of these topics have been researched with respect to surgery.

This article, written by members of the American College of Surgeons Resident and Associate Society (RAS-ACS), examines the literature on diversity and inclusion in surgery as it relates to trainees and leadership. It also offers recommendations and strategies to promote a more inclusive and diverse surgical workforce.

Read the full article on the Bulletin of the American College of Surgeons website.