Surgeons challenge tokenism and redefine belonging in pursuit of inclusivity

Medical: In a thought-provoking opinion piece, esteemed surgeons Dr Maxine Ronald, Dr Sarah Rennie and Professor Spencer Beasley shed light on the critical importance of belonging in the realm of diversity and inclusion. Their powerful message challenges the notion that mere tokenism can foster genuine progress. Instead, they argue for a transformative approach that reshapes institutions and values the contributions of underrepresented groups.

At the forefront of this paradigm shift stands the Royal Australasian College of Surgeons (RACS), which has embarked on a comprehensive update of its diversity and inclusion plan. While notable progress has been made, it is clear that not all targets and timelines have been fully met.

Initially, the focus on diversity and inclusion within surgery centered around gender and ethnicity, with a particular emphasis on ensuring the representation of Indigenous peoples. However, the scope of diversity and inclusion in healthcare extends far beyond these aspects. It encompasses underrepresented groups based on culture, disability, sexuality, socioeconomic status, rurality, and age. By recognising the multifaceted nature of diversity, RACS paves the way for a more inclusive healthcare landscape.

One of the fundamental challenges highlighted by the authors is the inherent bias within the surgical training and healthcare systems. Rooted in Western practices predominantly shaped by privileged, heterosexual, able-bodied white men, these systems fail to provide a safe space or a sense of belonging for individuals from underrepresented backgrounds. Trainees entering this environment often possess distinct worldviews, which can clash with established norms, leading to heightened stress and a feeling of not belonging.

To compound matters further, the current system tends to accept individuals from diverse backgrounds on the condition that they conform to the prevailing norms. This contradiction creates a paradoxical situation where inclusion is granted but true belonging and the ability to effect change are elusive. Initiatives that focus solely on increasing the numbers of underrepresented trainees without addressing these underlying issues are deemed tokenistic and fall short of genuine progress.

True progress, the authors argue, necessitates institutions’ willingness to accept diverse opinions, undergo transformational change, and embrace the value that diversity brings. This calls for uncomfortable yet necessary shifts in power dynamics, relinquishing influence over those who were previously considered “others.” Merely diversifying the selection process without fostering inclusive training programs and environments is insufficient. Institutions themselves must actively embrace change and provide the nurturing conditions that foster both inclusion and belonging.

The question arises: How do we define the best future trainees? What criteria should be used to assess their suitability? The authors propose that selection criteria should prioritise traits, skills, and values that reflect the communities being served, thereby elevating diversity as a priority. Rigid and inflexible systems that seek to mould individuals into a predefined image of the “best surgeon” may hinder the potential of diversity and the sense of belonging it engenders.

The authors emphasise that achieving diversity and inclusion alone is not enough; empowerment and belonging must be integral to the equation. A genuine sense of belonging enables the voices, beliefs, and values of all individuals to be heard, respected, and ultimately wield influence within institutions like RACS. Extensive evidence demonstrates that health disparities, particularly among Indigenous populations, stem from unconscious or conscious biases held by healthcare professionals. Patient outcomes also improve when individuals receive care from someone who shares their gender or ethnicity, creating a sense of comfort and rapport.

Truly effective diversity initiatives should not only reflect the communities they serve but also empower individuals from diverse backgrounds to shape policy and strategy. However, empowerment can only flourish within an environment of belonging. It is crucial for both diverse groups and the predominant group to recognise the need for change. When a sense of belonging is fostered for all, the College of Surgeons becomes stronger and better equipped to deliver improved health outcomes for all patients.

The perspectives put forth by Dr. Maxine Ronald, Dr. Sarah Rennie, and Professor Spencer Beasley have ignited a much-needed conversation within the medical community. Their call for a comprehensive shift towards inclusivity and belonging resonates not only within the corridors of RACS but across healthcare institutions nation-wide.

The road ahead is not without challenges. Institutions must grapple with ingrained biases and dismantle traditional systems that perpetuate the status quo. It requires discomfort and introspection to redefine what it means to be a successful surgeon and embrace the contributions of individuals from all walks of life. The journey towards true belonging demands courage, empathy, and an unwavering commitment to change.

However, the rewards are abundant. Research demonstrates that diverse teams foster innovation, improve decision-making, and deliver better outcomes for patients. By prioritising diversity and inclusion, RACS and other healthcare organisations can unlock the full potential of their workforce and forge a path towards equitable healthcare.

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