supporting a gender and racially diverse workforce during fellowship training and program director's perspective. Oops, wrong button. All right, so I am currently at Duke University Hospital. I am an anesthesiologist, board certified in anesthesiology and critical care medicine. I did my training at Wake Forest for medical school, made or built for residency and fellowship and currently practicing at Duke. I have no disclosures. So the objectives for my talk are looking at strategies to support female and underrepresented in medicine trainees in critical care medicine and pulmonary critical care fellowship through mentoring, family-friendly GME practices, leadership training and institutional changes. So this is gonna be the outline of my talk. So once again, we're gonna go through mentorship, family-friendly GME policies, leadership training and institutional changes to support our fellows. Going through mentorship. So starting out, we just heard a lot about mentoring and how important that is for our fellows and faculty, but identifying mentors and creating mentorship teams is super important for creating mentorship for our fellows. So in terms of identifying mentors, things that we can start out with is just identifying, pre-identifying mentors for our fellows. So having a diverse group of people to faculty or peers to support those fellows. So having women, having men, having people of different ethnicities, different religious beliefs, et cetera. All those kinds of things are super important to our trainees and supporting them with a group of pre-selected mentors who are willing and able to do that is really important. Looking at mentorship teams. So it's really hard for one individual to provide everything a mentor should be able to provide for each trainee. And so looking into mentorship teams, so teams that are able to support all aspects of a fellow's career, so professional development, emotional support, role modeling, giving them intellectual community, providing them a safe space, giving them accountability for their goals and their professionalism, access to opportunities, looking at sponsorship, and then providing feedback as well as professional development for our trainees. Next, we're gonna go into family-friendly GME policies. So there's a lot of information on this slide, but we're gonna go through a whole bunch of things, including scheduling, lactation, childcare, gender equality, and faculty and staff education. So starting out looking at scheduling. So scheduling is gonna be a big challenge for our fellows. Critical care fellowship, at least within anesthesiology and critical care, which is a one-year fellowship, is a very busy year. So looking at what is maternity leave for our fellows? When you have just one year to learn all that data, it's gonna be hard to have a substantial amount of time for maternity leave. And then secondarily, looking at daily scheduling. So people who already have children or others that they're taking care of, being able to provide that care with a busy schedule is gonna be challenging in taking those things into consideration for our trainees. Then moving on to women who are lactating. That's a really big issue within fellowship training. So the problem is lactation takes a lot of time. It's a really big time commitment for anybody who's done it before. It's every couple of hours, and it takes 20, 30 minutes, not including all the other things that you need to associate with that, including transport time to and from wherever you're gonna be doing that, and then getting back to your clinical responsibilities. Having a space to be able to do that safely, that includes having a table, sink, and a computer so that you can keep doing work while you're stuck there pumping. And then proximity to where these clinical workspaces are related to lactation rooms. So if it's across the hospital or a building away, that's a big problem for our trainees. Just case in point, this is an example of a lactation room at Duke University Hospital. You can see there's a sink here, there's a table here, there's a chair, it's great, we have a little pump. There's a computer here, but the big problem is this is not functional still, because once again, this is a battery-powered computer, and there's no battery. So as great as it looks on the outside, it is not functional. Moving on to resources. So a lot of people are gonna be first-time moms, first-time mothers, and so therefore there's gonna be a lot of barriers to that. Things that they don't know, resources they need. There's a multitude of literature or data, articles, whatever you wanna call it, whether it's clinical medicine or just kind of in popular culture, looking at barriers to breastfeeding, both for women in general, but more specifically for female physicians. So knowing that there's a lot of barriers for them and trying to provide solutions to these barriers is super important for our female trainees. And then looking at childcare. So this affects everybody, everybody with children, those without children, because then that leaves other people to try to cover when there are holes in childcare. So looking at median salary. So depending on what kind of fellow you are, anesthesiology, surgery, EM, pulmonary critical care, this is gonna be a list of median salaries for your fellow based on PGY years. So somewhere in the ballpark of 60s to $80,000. Next, if we look at childcare costs. So notably we have three different options here, daycare, au pair, and nanny. I'm sure there are other options, but these are kind of the most common options for our trainees. And then looking at annual costs and time. So a daycare is gonna be the most affordable option, it's about $12,000, plus or minus some, depending on your location. This provides about 35 hours a week of childcare. Notably, this is still deficient because I can guarantee as a former fellow, and in working, nobody works 35 hours a week. So that's a lot of time that you're not accounted for. An au pair is great, $25,000, provides about 45 hours a week of childcare. However, once again, we work more than 45 hours a week. And this also requires that you have the housing available to support an au pair living in your home. And then lastly, a nanny, which is a frequent option, however, also very pricey. So $40,000 or more, providing about 40 hours a week of childcare. So once again, still insufficient. But when you take these costs into consideration with a fellow salary, that's gonna be a substantial portion of their salary just to provide childcare so they continue to work and learn. Finally, taking into account all these hours, we don't include all the issues with daycare or childcare. So when people are ill, your child is ill, your childcare options are ill, and then these children are out of childcare more frequently and that provides a greater strain on our trainees. Looking at gender equality. So looking at gender equality, we no longer live in a leave it to beaver world with a cleaver family and a stay at home mom and a working father and 24 seven consistent childcare. We now have really diverse families. We have both working parents, we have stay at home fathers, we have working mothers, we have couples who are both working, who are not working, et cetera. And so that means that we have to take into consideration all these varieties and how that's put strains on our trainees. And so notably, I think normalizing the concept of paternity leave and increasing time for paternity leave because that also takes off the strain of our new mothers, providing childcare, fathers are still fathers and need to spend time with their children, including newborns. And so normalizing the concept of paternity leave and that amount of time males should be taking for paternity leave is incredibly important in addition to supporting maternity leave. And then lastly, faculty and staff education. So it's important that we're able to provide all these things. However, if your faculty or staff are unaware of some of these issues and they provide insensitive comments or discrimination against our trainees based on these needs, that is a problem. And so case in point, this is a, one of our fellows said this to one of our lactating fellows, is pumping a daily thing, isn't every other day thing? They literally just had no idea. And I'm not sure how to defend this because they went to medical school and had to go through all sorts of information, but here we are. So this just highlights the lack of awareness about the needs of some of our trainees and how we need to do better education to support them. All right, moving on to leadership training. So we're gonna go through understanding health inequity, DEI training, creative inclusive communities. Understanding health inequities. So this is an important topic brought up by some of our fellows who said, if we have diverse patient populations and understanding those issues related to those patient populations is incredibly important, both from a institutional standpoint as well as a faculty standpoint so that we do take into consideration issues within those patient populations. So looking at access to health inequities, so providing education, healthcare access to, healthcare access and quality to underrepresented patient populations, looking at neighborhood and physical environments for those patients, looking at the community social context that these patients live in, looking at economic stability when we look at discharge options and how they got to the state, workplace conditions or whether or not they're able to get work are all important aspects of looking at health inequity and providing better education to our entire medical population so that we're able to support DEI in our patient populations as well as our trainees. Looking at DEI training, so this is something that has gained a lot of popularity of late. However, this includes a lot of things. This is not a one-time educational opportunity that you learn and you're able to retain forever. This requires kind of continual education and so that includes starting with training, making sure we have engagement within those trainees, looking at workforce recruitment, measuring the impact of all of your measures so far and then continuing education development. So similar to kind of a PVLD or a QI model where you're looking through assessing, creating solutions and then continue to reassess how your solutions are working and then looking at creating inclusive committees. So it's important for our committees to look like the fellows and trainees that we are wanting to include. So notably, these are two articles looking at gender imbalances in ICU and as well as gender and diversity inclusion and anesthesiology. Both these papers basically look at the number of quote unquote women within intensive care. So we've already discussed how there's already an imbalance of the number of women physicians compared to the number of women within ICU and then also looking at kind of the number of females within the anesthesiology departments and how many of those women are notably in leadership. So I think this paper really highlights maybe like a single digit percentage of female department chairs whereas there's probably 40 to 50% of anesthesiologists are females and that's a great gender imbalance and making sure those leadership committees include more females is incredibly important to improving our practices. Finally, looking at institutional changes. So we have institutional code of conducts to discuss as well as affordable childcare and designing functional spaces. So when we look at institutional codes of conduct, it's important to hold, to have number one, a code of conduct for our institutions but also holding people accountable. So thank you to the SECM as well as our local institution UCSF as well as my home institution, Duke University Hospital for having offices of institutional equity and having standards of conduct posted along our webpages so that everybody's able to access them and see them and then understand what the consequences are when you do not act professionally. Secondarily, looking at affordable childcare. So we already talked about how unaffordable childcare is for our trainees. And so institutions can provide daycare centers to help offset those issues. And so having daycare centers with flexible hours is very important because we work at crazy hours, very early hours, very late hours, having those hours that allow for our trainees to be able to get childcare. Affordability is a big one. So we talked about how incredibly expensive childcare is. And so making sure that we're not creating unaffordable childcare for trainees if they want to continue training. Looking at ease of entry. So if you talk to any parents or new parents, you have heard probably from your friends or colleagues or whoever, getting into daycare is challenging. There are wait lists, there are years long wait lists. I mean, it only takes nine months to create a baby and it takes two years to get off a wait list. You don't even have a child by then. So it's very hard to get into daycare. And so having an ease of entry into that would be incredibly helpful for our trainees. Also notably, as our trainees are coming in for potentially one year fellowships, that's a really hard transition, especially if you don't know where you're going to be able to create that option for you. And then the convenience. So having a childcare facility on campus within hospital grounds is just much more convenient than having to drive at 5 a.m. to wherever you need to go to drop off your child and then get to the hospital to get to grounds on time. Lastly, looking at designing functional spaces. So we talked a lot about, I showed you a picture of a lactation room and so we already looked at things like that. So access to accessibility in clinical areas is a really important thing. So one of the great things that Duke does have is that we have lactation rooms on every floor. So that provides options so you don't have to walk halfway across the hospital or to a separate building to be able to get access to that. So that's nice, but also having a functional workspace for lactation rooms or any kind of space where you need to be able to do work and be able to do other things that you need to do. So having a functional computer would be great or workstations that have battery power or are plugged into the wall, super important. But that's all I have to cover. So thank you guys. These are all the people I've spoken to and probably some more about this talk to be able to create all this content for you guys. So thank you to everybody. Thank you to SCCM for inviting me. Thank you.

mentorship

diverse mentorship teams

family-friendly policies

leadership training

institutional changes