I am Wendy Ricketts-Green and a professor of surgery and critical care at Emory University. Thank you to the Society of Critical Care Medicine Program Planning Committee for the opportunity to be a part of this discussion regarding the intersectionality of ethnicity and gender in critical care, how to succeed when you are the one and only in the room. Being a woman of color in an academic surgery and critical care often means being the only one, if not one of the only ones, in the classroom, operating room, and in the intensive care unit. It also means that rules of success are somewhat different than they are for others. I was fortunate to attend a diverse medical school class at Howard University in Washington D.C. and have a number of women in my surgical residency training program. I had little exposure to female faculty in my surgery and critical care training, but greatly appreciated those that were around, watching them navigate and hold their own during critical decision-making opportunities. So as a background, there is data that we need to evaluate to help us find new opportunities for success. If we look at Elrich and colleagues who reviewed the gender distribution of current surgical critical care fellows, faculty, and program directors, they found in their cross-sectional analysis investigating the websites of all 106 U.S.-based surgical critical care fellowships, a total of 116 surgical critical care fellows were included in this analysis, comprising 59% men and 40% women. There were 977 surgical critical care fellowship faculty who were evaluated, and they comprised 68% men and 32% women. Additionally, 103 surgical critical care fellowship program directors were analyzed, consisting of 75% men and 25% women. There is a significantly lower proportion of women fellows and faculty members compared to men. Additional research has shown that there is also a speaker gender gap at critical care conferences, with male faculty outnumbering female faculty. This gap is more marked among physician speakers than those speakers representing nursing and allied health professions. Over the seven years, Society of Critical Care Medicine had the highest representation of females, 27% overall, and nursing allied health professionals, 16-25% of the speakers. Notably, male physicians substantially outnumbered female physicians in all years, 62-70% versus 10-19% respectively. This study, however, did not look at diversity in leadership at the board or society presidential levels. The first steps to success is to step out on faith, and don't let others define you. Steve Harvey put this well in his book, Jump. We're all born with special gifts, and in order to be successful, we need to find these and operate in them. Define your own meaning of success. Continually stretch ourselves to our limits to experience the fullness of our purpose. We must continually grow. Processes take time and may even hurt. Every time you decide to stretch yourself to do more, be more, accomplish more, you'll take risks, you'll face opposition, and the process will seriously suck sometimes at some point or another, but if you stick to it, you will make it. Don't let others define you. As a woman of color in the world of academic surgery and critical care, I've also had to learn that the rules for women of color at work and within national societies are different. There are so few of us as we're also faced with a double bias of being women and of a different ethnicity. While speaking up and raising our voices may be encouraged for everyone else, they may be interpreted differently for women of color, hence the angry black woman and other stereotypes of the same kind. So how do we counteract the angry black woman stereotypes? We must separate ourselves from the stereotype. This has turned out to be more of a mental exercise than anything else. No one is confined to a single stereotype or idea of who they are, wherever this idea may be coming from. And once we separate ourselves from what others may be thinking of us and concentrate on our values, work, and ethics, we will tend to see less and less of these very, very negative stereotypes. And the less we internalize the negative, the more we externalize the authenticity of who we are and place ourselves in a frame of mind to produce our best results. And in the process, change the very mentalities and perceptions that threaten to plague our success. We also need to choose our battles wisely. Hold your tongue, don't press send, pause, breathe, reflect, and return to the situation with a fresh perspective. When underrepresented minorities, cultural and social stereotypes are added to the mix of conversations and discussions, things can be complicated. And while it may be difficult, it can certainly pay to evaluate the consequences of every interaction. Pick the professional battles that are worth it and steer clear from anything detrimental to our careers and professional advancement. Document, document, document. In most professional environments, the power of the written word is still very much prevalent. Write it down from work achievements to conflict resolutions in the workplace. Documentation is always, always your best ally. Based on the writings of Solange Lopez, who is an author, CPA, and writer-blogger, I have found some additional wonderful tips for success. Stop being afraid of being yourself. The imposter syndrome is real, but you have to encourage yourself that you deserve to be at the table because you are smart, innovative, and compassionate. Privacy is the best way to change the dialogue about women of color at work. The more we hide behind our masks, the less we can bring focus on the actual issues faced by women of color at work. Get used to being uncomfortable. Being a woman of color at work rhymes with being uncomfortable. Not only are there very few other women of color in the room, but our lack of representation can also make it challenging for others to understand the struggles we may face. However, being uncomfortable is also an advantage. The more uncomfortable you are, the more prepared you tend to be. Getting used to uncomfortable and challenging environments is also the key to being innovative and a high performer. Find your sweet spot. There are many challenges associated with being a woman of color in an academic environment, yet they shouldn't prevent you from excelling and being the best you can be. Finding your sweet spot, where there is overlap between your skills, interests, and opportunities, and this is crucial to achieving success, especially as a woman of color at work. The reality is, very often, you may have to work harder and at convincing others of your competence and professionalism. The mantra in our surgical training that came from the words of Charles R. Drew, excellence of performance transcends artificial barriers created by man, and that this competitive edge is needed to attract the right opportunities. Speak up and speak out. Challenge yourself to be a voice. As a woman of color at work can be double-edged sword. On one hand, you may be labeled as too assertive or downright angry. On the other hand, not raising your voice may make you seem incompetent or disinterested. Whatever bias you may have to confront, I've found that the best answer more often than not is to speak up. You have way too much knowledge, insight, and experience not to share it to empower others and increase your team and organization's efficiency. Keep showing up. As a woman of color in academic surgical critical care, there were many times when I was tempted to stop showing up. For many of us, the challenges can be so overwhelming that we may think of giving up. Stopping to volunteer or participate or even flat out resign. Keep showing up, persevering, and demonstrating your best efforts. While your work may go unnoticed at times, it's important to consistently show up and bring your best. Share your experience. We may face numerous challenges at work, but we rarely share our experiences to help others understand us better. The reality is there is always going to be a certain level of unconscious bias embedded in people. It's up to us to change the norm by changing others' understanding of who we are and what we experience. I created an infinity group for African American women at Emory School of Medicine to combat isolationism and provide a safe space for conversations, collaborative research, think tank, amplification of excellence, encouragement, and fellowship. These were all important principles that you should also incorporate into your environment. 4. Behavior Dispel Stereotypes. Stereotypes such as the angry black woman and other preconceived and generally false ideas about women of color may not disappear anytime soon. However, the most effective way to dispel them and prove some of the myths and beliefs around women of color are wrong is through consistent positive behavior. Be open to change. Progress and growth require change. As women of color at work, our career paths may not always be predictable for a host of obvious and some not so obvious reasons. To circumvent many of the barriers standing in the way of women's leadership and advancement, we must learn to welcome and embrace change. In summary, remember the words of Maya Angelou, phenomenal woman. As you progress along your career, you can adapt and change as you become who you are destined to be. Early in your career, remember who you are and whose you are. Be confident in your education, training, and professional acumen. Be excellent, but give yourself grace when you are not. Treat people the way you would want to be treated. Be your authentic self when the surroundings are safe. Code switch when needed. Facilitate conversations with those who are willing to listen and learn. Create a safe space in unfamiliar surroundings. Find allies as you cannot live in a vacuum. Have a plan B. Don't put all your eggs in one basket. Now, I know the imposter syndrome is real, so you have to combat that with being twice as good as your colleagues. Be a team player. Find allies within and outside your department. Volunteer. Share about your culture to those who are actively learning about cultural humility and disparities. As a mid-career strategy, mentorship is important. You need to be able to echo and affirm your colleagues' voice in the room. Work on national guidelines. Take challenges and risks. Move out of your comfort zone as you participate in national societies that support your unique demographic. As a senior care strategy, you want to create opportunities for others through sponsorship. You need to be the voice that your junior colleagues cannot be. You have to be able to have the difficult conversations in the organization professionally and personally. Be at the table and open doors for others. I would like to thank the trailblazer in surgery that created opportunities for me at Emory. In 1975, Dr. Asa Yancey was the first African-American professor of surgery at Emory University. And in 2021, I became the first African-American female professor of surgery at Emory. Thank you for the opportunity to speak.

woman of color

academic surgery

critical care

underrepresentation

success strategies