Programmatic engagement in diversity, equity, and inclusion in U.S. vascular surgery training programs

Given the diversity of populations that modern healthcare professionals treat, there has been an increasing call for academic medical centers to ensure that they themselves are diverse and inclusive. Historically, this has been measured by the composition of the workforce in terms of protected categories such as race/ethnicity, gender, and disability. However, these broad categories have only poorly reflected the actual ability of organizations to engage with a diverse workforce and patient population. The diversity and engagement survey (DES) is a specifically constructed and validated instrument designed to measure the integration of diversity, equity, and inclusion (DEI) within academic medical centers. The goal of the present study was to use the DES with vascular surgery program directors, to determine the predictors of low DEI in vascular surgery training programs.

An anonymous electronic survey was sent to all program directors and assistant program directors of vascular surgery training programs (residencies and fellowships) in the United States (n = 280). The survey consisted of 18 sections with 53 questions regarding details of the respondent, demographics, programmatic information, including information on faculty and trainee diversity, the resources available to enhance DEI within the program, institutional attitudes toward employees, and the DES itself. The total score from the DES section was used to the stratify institutions, which were classified as low DEI if in the bottom 25% percentile of the overall scores or as high DEI if scoring higher. Univariate analysis was used to determine whether any important differences were present in the demographics or survey responses between the institutions scoring as low vs high DEI. Multivariate logistic regression was also performed using the demographic variables and responses to the survey questions to determine their relationship to DEI status.

There were a total of 102 complete responses to the survey (36.4% response rate). The proportion of women was higher (66.67%) than the men (33.30%) in the low DEI cohort, although women were only 28.4% of the overall cohort. A statistically significant difference was found between the high and low DEI institutions in the proportion of those who had responded yes, no, or preferred not to disclose whether they had experienced discrimination or hurtful comments (P < .001) with 71% of the respondents in the low DEI institutions reporting this experience compared with only 11% in high DEI institutions. Multivariate analysis also demonstrated that non-male gender (odds ratio, 5.10; P = .034) and experiences of discrimination (odds ratio, 6.51; P = .024) were associated with low DEI institutions.

Non-male program directors and those who had experienced discrimination at their institution were significantly more likely to find that their institution had low DEI.