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Equity, Diversity, and Inclusion in Departments of Obstetrics, Gynaecology, and Reproductive Health

  • Cynthia Maxwell
    Affiliations
    Department of Obstetrics and Gynecology, Sinai Health, Mount Sinai Hospital, Toronto, ON

    Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
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  • Gianni R. Lorello
    Affiliations
    Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON

    Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON

    The Wilson Centre, Toronto, ON
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      Equity has gained importance for patient care, clinical research, and medical education. As providers of and leaders in women's reproductive health care, we may benefit from a closer examination of equitable distribution amongst ourselves. “We All Belong” is the theme of a call to action, a campaign for “excellence through equity” in our Faculty of Medicine.

      University of Toronto Faculty of Medicine. Academic strategic plan 2019. Available at: https://medicine.utoronto.ca/asp/create-resource-comprehensive-equity-diversity-inclusion-plan. Accessed on March 27, 2020.

      Situated in one of Canada's largest and most diverse cities and with numerous affiliated academic hospitals and birthing centres, we are being asked the following questions: Does our workforce, which includes obstetrical providers in family medicine and midwifery, reflect the populations we serve? How do we support those members of socially underrepresented groups with whom we work? And why do equity, diversity, and inclusion (EDI) matter?
      We hope to be one of many departments of obstetrics, gynaecology, and reproductive health to launch a leadership role for EDI (please refer to Box 1 for definitions

      Ontario Human Rights Commission. Appendix 1: glossary of human rights terms. Available at: http://www.ohrc.on.ca/en/teaching-human-rights-ontario-guide-ontario-schools/appendix-1-glossary-humanrights-terms. Accessed on March 27, 2020.

      Association of American Medical Colleges. Group on Diversity and Inclusion. Available at: https://www.aamc.org/members/gdi/. Accessed March 27, 2020.

      University of Toronto Faculty of Medicine. Allyship and inclusion at the Faculty of Medicine. Ally definitions. Available at: https://medicine.utoronto.ca/allyship-and-inclusion-faculty-medicine. Accessed on March 27, 2020.

      ). Because our specialty focuses on women's health, we have unique features that affect the equity and inclusiveness of our working environment. We have increasing numbers of women in our obstetrical trainee and professional workforce, and fewer men are entering our specialty (Table 1). Very few departments of obstetrics and gynaecology collect data on the diversity of their faculty and thus are potentially unaware of how representative their workforce is. Without this collective self-awareness, we may be less well positioned to support trainees and colleagues who identify with socially underrepresented or equity-seeking groups (Box 2) and who may be subject to discrimination and harassment.
      Box 1Definitions of equity, diversity, inclusion, and allyship
      EquityImplies fairness, impartiality, even-handedness. A distinct process of recognizing differences within groups of individuals and using this understanding to achieve substantive equality in all aspects of a person's life.

      Ontario Human Rights Commission. Appendix 1: glossary of human rights terms. Available at: http://www.ohrc.on.ca/en/teaching-human-rights-ontario-guide-ontario-schools/appendix-1-glossary-humanrights-terms. Accessed on March 27, 2020.

      DiversityDiversity embodies inclusiveness, mutual respect, and multiple perspectives and serves as a catalyst for change, resulting in health equity. In this context, we are mindful of all aspects of human differences, such as socioeconomic status, race, ethnicity, language, nationality, sex, gender identity, sexual orientation, religion, geography, disability, and age.

      Association of American Medical Colleges. Group on Diversity and Inclusion. Available at: https://www.aamc.org/members/gdi/. Accessed March 27, 2020.

      InclusionInclusion is a core element for successfully achieving diversity. Inclusion is achieved by nurturing the climate and culture of the institution through professional development, education, policy, and practice. The objective is to create a climate that fosters belonging, respect, and value for all and encourage engagement and connection throughout the institution and community.

      Association of American Medical Colleges. Group on Diversity and Inclusion. Available at: https://www.aamc.org/members/gdi/. Accessed March 27, 2020.

      AllyshipAllies stand up for others, including their peers and colleagues, when they witness discrimination, harassment, or offensive comments or conduct by others.

      University of Toronto Faculty of Medicine. Allyship and inclusion at the Faculty of Medicine. Ally definitions. Available at: https://medicine.utoronto.ca/allyship-and-inclusion-faculty-medicine. Accessed on March 27, 2020.

      Table 1Distribution of Canadian obstetricians and gynaecologists by sex
      YearFemale, %Male, %Obstetrician-gynaecologists, N
      200030.669.41566

      Canadian Medical Association. Number and percent distribution of physicians by specialty and sex, Canada 2010. Available at: https://www.cma.ca/sites/default/files/2019-03/2000-06-spec-sex.pdf. Accessed March 27, 2020.

      201453.146.91972

      Canadian Medical Association. Number and percent distribution of physicians by specialty and sex, Canada 2014. Available at: https://www.cma.ca/sites/default/files/2019-03/2014-06-spec-sex.pdf. Accessed on March 27, 2020.

      201961.838.22113

      Canadian Medical Association. Number and percent distribution of physicians by specialty and sex, Canada 2019. Available at: https://www.cma.ca/sites/default/files/2019-11/2019-06-spec-sex_0.pdf. Accessed on March 27, 2020.

      Box 2Socially underrepresented groups and equity-seeking group categories
      Groups
       Women
       Minorities or racialized persons, including Black, Filipino, and Indigenous persons
       Differently abled persons and persons with disabilities
       LGBTQ2: Lesbian, gay, bisexual, transgender, queer or questioning, and two spirit
      Group categories
       Gender
       Age
       Socioeconomic status
      Having a representative workforce familiar with issues of diversity and inclusion can provide important role modeling for our trainees. We will be providing reproductive care to patients who self-identify as transgender, but we have little or no training in the simplest terminology, such as appropriate pronouns (these include feminine pronouns she, her, hers, and herself; masculine pronouns he, him, his, and himself; and gender-neutral pronouns they, them, and theirs and ze, zir, and zirs)

      Harvard Medical School Office for Diversity Inclusion and Community Partnership. Terminology related to sexual orientation, gender identity and more. Available at: https://mfdp.med.harvard.edu/sites/default/files/files/HMS%20SOGI%20terminology%203.22.17.pdf. Accessed on March 27, 2020.

      to use in the office setting and even less so in inter- and intraprofessional communication. Our obstetrical sonography and delivery room language often refers to a dichotomy of fetal gender rather than fetal sex, potentially leading to feelings of exclusion among gender-diverse people and parents who may not view their child according to the traditional gender binaries of “boy” or “girl.”
      The EDI officer's mandate is to support the department in areas of medical and professional education, admissions proceedings, recruitment, and hiring. Because issues of equity and inclusion are central to hospital and educational program accreditation, in-depth understanding and planning at the organizational level will be crucial to the academic mission. Funding from organizations such as the Canadian Institutes for Health Research and Canada Research Chairs

      Government of Canada, Canada Research Chairs. Equity, diversity and inclusion requirements and practices. Available at: https://www.chairs-chaires.gc.ca/program-programme/equity-equite/index-eng.aspx. Accessed on March 27, 2020

      stipulates that recipient institutions comply with and adhere to equity practices.
      Is there a precedent for successful implementation of an equity role? Other departments have outlined blueprints for EDI work, with embedded audits assessing their current work environments for diversity, identifying disparities and knowledge gaps, and sharing results and suggestions for improvement.
      • Lorello GR
      Leading progress: the role of the chief diversity office in anesthesiology departments.
      Better understanding of the mechanisms leading to gender disparities and identification of gap-closing projects will ultimately lead to improved work environments with increased collegiality.

      Canadian Medical Association. Addressing gender equity and diversity in canada's medical profession: a review. Available at: https://www.cma.ca/sites/default/files/pdf/Ethics/report-2018-equity-diversity-medicine-e.pdf. Accessed on March 27, 2020.

      Where do we start? Although establishing an EDI officer role may require some resources and advanced planning, many simple steps can be taken by a department. All faculty members, staff, and learners can benefit from understanding the basic EDI concepts and understanding everyone's responsibility to recognize and support others—the concept of being an ally (see Box 1 for definition). Leaders can support postgraduate and continuing professional education by including syllabus statements on values and equity. Education on inclusion and avoidance of harassment and discrimination can form part of the education needed to reapply for credentialing.
      Returning to the question of relevance: Why does any of this matter? We may find answers in data and knowledge. Diversity and inclusion of people and ideas drives innovation and excellence.
      • Swartz T
      • Palermo A
      • Masur S
      • Aberg J
      The science and value of diversity: closing the gaps in our understanding of inclusion and diversity.
      Innovation and excellence are needed to continue to advance our field and support our patients, families, and the reproductive community.

      REFERENCES

      1. University of Toronto Faculty of Medicine. Academic strategic plan 2019. Available at: https://medicine.utoronto.ca/asp/create-resource-comprehensive-equity-diversity-inclusion-plan. Accessed on March 27, 2020.

      2. Ontario Human Rights Commission. Appendix 1: glossary of human rights terms. Available at: http://www.ohrc.on.ca/en/teaching-human-rights-ontario-guide-ontario-schools/appendix-1-glossary-humanrights-terms. Accessed on March 27, 2020.

      3. Association of American Medical Colleges. Group on Diversity and Inclusion. Available at: https://www.aamc.org/members/gdi/. Accessed March 27, 2020.

      4. University of Toronto Faculty of Medicine. Allyship and inclusion at the Faculty of Medicine. Ally definitions. Available at: https://medicine.utoronto.ca/allyship-and-inclusion-faculty-medicine. Accessed on March 27, 2020.

      5. Harvard Medical School Office for Diversity Inclusion and Community Partnership. Terminology related to sexual orientation, gender identity and more. Available at: https://mfdp.med.harvard.edu/sites/default/files/files/HMS%20SOGI%20terminology%203.22.17.pdf. Accessed on March 27, 2020.

      6. Government of Canada, Canada Research Chairs. Equity, diversity and inclusion requirements and practices. Available at: https://www.chairs-chaires.gc.ca/program-programme/equity-equite/index-eng.aspx. Accessed on March 27, 2020

        • Lorello GR
        Leading progress: the role of the chief diversity office in anesthesiology departments.
        Can J Anaesth. 2020; 67: 612-614
      7. Canadian Medical Association. Addressing gender equity and diversity in canada's medical profession: a review. Available at: https://www.cma.ca/sites/default/files/pdf/Ethics/report-2018-equity-diversity-medicine-e.pdf. Accessed on March 27, 2020.

        • Swartz T
        • Palermo A
        • Masur S
        • Aberg J
        The science and value of diversity: closing the gaps in our understanding of inclusion and diversity.
        J Infect Dis. 2019; 220: S33-S41
      8. Canadian Medical Association. Number and percent distribution of physicians by specialty and sex, Canada 2010. Available at: https://www.cma.ca/sites/default/files/2019-03/2000-06-spec-sex.pdf. Accessed March 27, 2020.

      9. Canadian Medical Association. Number and percent distribution of physicians by specialty and sex, Canada 2014. Available at: https://www.cma.ca/sites/default/files/2019-03/2014-06-spec-sex.pdf. Accessed on March 27, 2020.

      10. Canadian Medical Association. Number and percent distribution of physicians by specialty and sex, Canada 2019. Available at: https://www.cma.ca/sites/default/files/2019-11/2019-06-spec-sex_0.pdf. Accessed on March 27, 2020.

      Linked Article

      • Letter: Equity, Diversity and Inclusion in Departments of Obstetrics, Gynaecology and Reproductive Health
        Journal of Obstetrics and Gynaecology Canada Vol. 43Issue 1
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          I read the editorial “Equity, Diversity and Inclusion in Departments of Obstetrics, Gynaecology and Reproductive Health” by Maxwell and Lorello1 with great interest. As a person who identifies as belonging to a minority group, I applaud the effort made to create this leadership role for equity, diversity, and inclusion (EDI).
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      • Équité, diversité et inclusion dans les départements d'obstétrique, de gynécologie et de santé reproductive
        Journal of Obstetrics and Gynaecology Canada Vol. 42Issue 8
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          L’équité a gagné en importance relativement aux soins aux patientes, à la recherche clinique et à la formation médicale. En tant que leaders et fournisseurs de soins en santé reproductive des femmes, nous gagnerions à analyser en profondeur la distribution équitable entre nous. « Nous avons tous notre place » est le thème d'un appel à l'action, une campagne pour « l'excellence par l’équité » au sein de notre faculté de médecine1. Comme nous sommes situés dans l'une des villes canadiennes les plus populeuses et diversifiées où se trouvent plusieurs centres hospitaliers universitaires et centres de naissance, on nous pose les questions suivantes : Notre personnel, qui comprend des fournisseurs de soins obstétricaux en médecine familiale et en services de sages-femmes, reflète-t-il la population que nous servons? Comment soutenons-nous les membres des groupes socialement sous-représentés avec lesquels nous travaillons? Et pourquoi l’équité, la diversité et l'inclusion (EDI) sont-elles importantes?
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