S. Braafladt1,3, K. Manohar1, M. Blackwell1, D. Doster1, M. Bhatia1, J. Lee1, A. A. Gonzalez1,2,3 1Indiana University School Of Medicine, Department Of Surgery, Indianapolis, IN, USA 2Indiana University School Of Medicine, Division Of Vascular Surgery, Indianapolis, IN, USA 3Regenstrief Institute, Center For Health Services Research, Indianapolis, IN, USA
Introduction: According to the World Health Organization, social determinants of health (SDH) account for 30-55% of the variation in surgical outcomes. Thus, improving perioperative outcomes requires training care team members to recognize disparities in surgical care. In 2020, our institution implemented a quarterly Surgical Disparity Morbidity and Mortality conference (M&M) to highlight the effects of SDH on surgical outcomes. The objective of this study was to examine the perceptions and impact of Surgical Disparity M&M on trainees and attendings.
Methods: We surveyed Surgical Disparity M&M conference attendees in May 2023 via QR code and follow-up email. Demographic data and level of training were collected. This was followed by a series of questions to determine respondent’s prior experience in receiving education in disparities, their comfort level in recognizing disparities, and any practice changes resultant from attending Surgical Disparity M&M. Participation was voluntary. Results were compiled and thematic analysis was performed on short-answer responses.
Results: There were 49 total respondents (20 attendings, 23 residents or fellows, 5 medical students, 1 physician assistant student). Fifty one percent of respondents were female, and 66.7% white/Caucasian, 25.9% Asian, 2.1% each Black/African American and Middle Eastern/North African, 4.2% prefer not to say/not listed, and 4.2% of Hispanic, Latino, or Spanish origin. Almost half (49.0%) reported previous formal surgical disparity education with 31.4% received during medical school, 34.3% during graduate medical education, and 31.4% during continued medical education. While only 21% of respondents “strongly agreed” with feeling comfortable identifying perioperative SDH, 92% reported interest in further education on perioperative disparities within their own practice. Two-thirds (66.7%) of respondents report they plan to change some aspect of their patient care based on discussions in Surgical Disparity M&M. Thematic analysis from the question “What do you plan to change about your care of patients because of these discussions?” revealed intentions to be deliberate about identifying disparities in practice for education and spending more time discussing with patients and families their perspectives and goals of care.
Conclusion: Surgical Disparity M&Ms educated attendees on the contribution of SDHs to surgical outcomes. Survey respondents revealed a desire for further education on SDH and surgical disparities beyond Surgical Disparity M&Ms. More importantly, in response to Surgical Disparity M&M, most respondents report an intent to change an aspect of their practice to mitigate health care disparities. Planned future directions of this work involve expanding beyond our Surgical Disparity M&M to incorporate a more formal curricula including educational modules and involvement of the multidisciplinary surgical care team.