Fifty physicians from across the province gathered virtually to discuss the ongoing issues of equity, diversity, and inclusion (EDI) in medicine at the Specialist Services Committee’s (SSC) Equity, Diversity, and Inclusion: Elusive Dream or Achievable Reality workshop.
The workshop audience comprised of both specialists and family physicians, and featured five speakers who shared their unique perspectives, lived experiences, and extensive research on the existing barriers to EDI and the importance of representation in medicine. At the end of the day, an interactive discussion was opened for all participants to share their thoughts and connect with each other to build a network of colleagues for ongoing collaboration and support.
Cultural Safety and Humility – Dr Shannon McDonald
Dr Shannon McDonald, Acting Chief Medical Officer for First Nations Health Authority, shared the existing initiatives underway to advance cultural safety and humility across the province. She also discussed the Doctors of BC’s Indigenous Cultural Safety and Humility plan which aims to enhance knowledge about cultural safety and humility, engage First Nations communities, fund local initiatives, and implement projects that make a difference for Indigenous patients.
Dr McDonald emphasized that it’s critical to recognize that cultural safety and humility is not optional or exceptional to existing standards of care – they are Indigenous rights, patient rights, and human rights.
EDI in Medicine – Dr Faisal Khosa
Dr Faisal Khosa, Radiologist at the University of British Columbia, explained three key concepts that explored the prevalence of disparities in all levels of the academia pipeline: “The Sticky Floor”, “The Broken Ladder”, and “The Glass Ceiling”.
The Sticky Floor is a metaphor for when progress of select demographics is blocked by design. The Broken Ladder explains how leadership positions are passed amongst individuals of a certain demographic, often without the job being posted. And the Glass Ceiling represents women and other minority groups who are routinely made to feel they are under or over qualified for job positions and never appropriately qualified for opportunities.
Dr Khosa’s presentation ended by encouraging participants to think of ways to address systemic and structural biases and barriers within our medical system.
Black Perspective on EDI – Dr Marissa Joseph
Dr Marissa Joseph, Dermatologist and Pediatrician at the University of Toronto, shared that despite being a minority group in the Toronto population, Black patients held a disproportionately large share of COVID-19 cases.
Even though there has been considerable anti-Black racism work in the past century, there is no room for complacency. In 1918, the university senate at Queen’s University voted to ban Black students from admission to the medical program. Black students were not welcomed back until the 1960s. Although this anti-Black practice was no longer enforced after 1965, it remained on the books as policy until 2018.
Systemic racism is still very much an issue in medicine and a public health crisis. Dr Joseph encouraged all physicians to evaluate their own implicit biases.
Working with the LGBTQIA2S+ Community – Dr Philip Doiron
Dr Philip Doiron, Dermatologist at the University of Toronto, explained how LGBTQIA2S+ persons face unique challenges, frequent stigma, and disproportionate barriers accessing equitable health care. Although each of the categories making up the LGBTQIA2S+ identities were reviewed during the presentation, Dr Doiron emphasized that everyone is unique, and the categories may not adequately encompass all members of the community. Health care settings are often the first place some “come out” or seek resources, and as physicians, Dr Doiron stated that it is our responsibility to provide affirmative, inclusive, and respectful care.
Dr Doiron left participants with five communication tips to use in the medical setting:
- Avoid assumptions (every person, whether transgender or cisgender, has a different relationship with their body and may not have the same end point/goals of care)
- Let LGBTQIA2S+ people describe themselves in language they prefer (e.g., when a patient describes themselves as “lesbian”, use the word “lesbian”, not “homosexual”),
- Ask patients their pronouns and avoid using pronouns until they have been confirmed
- Be sensitive when taking medical/surgical/social history (e.g., trans individuals are constantly being asked about their bodies).
- Most importantly, when you misstep, practice self-compassion and forgive yourself, then take it as a learning opportunity to become a better ally.
Gender Diverse Representation and Allyship in Medicine – Dr Blair Peters
In his presentation, Dr Blair Peters, plastic and reconstructive surgeon and assistant professor of surgery at Oregon Health and Science University, stated that many queer individuals in medicine have operated under a “don’t ask, don’t tell” type of culture. Many institutions are underway targeting increased diversity, but increasing the number of LGBTQIA2S+ individuals/faculty does not necessarily change the culture of the organization, nor will it ensure that people feel included and valued. Inclusion is more than being present, it is a “feeling of belonging.”
The narrative of heterosexuality and a gender binary is dominant throughout medical culture and training, and there is an undercurrent and feeling that one must assimilate to succeed. Dr Peters emphasized that if we want increased representation, then we must provide an environment that allows for it – this is where everyone has a role to play to improve the experiences of transgender and nonbinary colleagues. Instead of remaining in a neutral position or as a passive ally, it is important to shift the spectrum and to become an active ally (to educate oneself, identify and interrupt inappropriate behaviors, educate others, and initiate an organized response).
In terms of making a difference in patient care, Dr Peters encouraged attendees to review how to create a gender affirming environment for their patients.
Stay tuned for similar EDI workshops hosted by the SSC in 2023.