Moving Beyond Diversity: A Scoping Review of Inclusion Initiatives in the Surgical Workforce

Addressing racial disparities within the surgical workforce is vital to provide quality care to all patients; inclusion is critical to do so. Inclusion signifies a move beyond numerical representation; tangible goals include reducing attrition and maximizing career development. The aims of this review were to (1) test whether there are academically published interventions or frameworks addressing inclusion in the surgical workforce and (2) characterize these interventions or frameworks. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three electronic databases (Medline, PubMed, Web of Science) were queried. Peer-reviewed full-text English-language articles focused on interventions or frameworks to achieve inclusion in the surgical workforce were considered. The initial search yielded 2243 papers; 15 met inclusion criteria. The published literature regarding interventions to achieve inclusion was sparse; the most common reasons for exclusion of full texts were papers not focused on interventions (42%; n = 51) or purely focused on diversity and representation (36%; n = 42). The most common field represented was broadly academic surgery (4/15; 47%), with seven other subspecialties represented. A small minority received funding (3/15; 20%). Common themes included systematic reform of recruitment policies and practices, increased access to targeted mentorship, gaining leadership support, and increased avenues for underrepresented faculty advancement. While limited, promising work has been undertaken through national collaboration and model institutional work. Future considerations may include incentivizing academic publication of inclusion work, increasing access to funding, and rewarding these efforts in career advancement.