‘Michigan Promise’ Aims to Diversify, Strengthen Surgical Field

How a transformative long-term model plans to reshape the culture of hiring, mentoring and advancement of early-career surgeons at Michigan Medicine.

10:37 AM

Author | Kevin Joy

To best serve a diverse patient population, surgeons should look more like the people they treat. That's part of the thinking behind the Michigan Promise, a transformative long-term  effort at the Michigan Medicine Department of Surgery.

But the endeavor — a six-part initiative first proposed in 2015 — isn't just about ensuring optimal patient care. It's also designed to attract a broader pool of skilled surgical candidates that might otherwise be overlooked or who consider an opportunity to be out of reach.

The shift is long overdue for a field in need of balance, says Michael Mulholland, M.D., Ph.D., senior associate dean of clinical affairs at the University of Michigan Medical School.

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"Thirty years ago, if you thought surgeons were all men, all extroverted, all action-oriented, then you mostly saw and developed people like that," says Mulholland, who until June chaired the department of surgery at the U-M medical school.

"In doing so, you ended up with teams that all looked the same, and whose performance was limited because their repertoire of knowledge and behavior and experience was also limited."

The need is there. According to data cited by the American Medical Association, many popular surgical fields are dominated by men, including orthopedic surgery (85.1%); neurological surgery (82.5%); and thoracic surgery (73.8%). Overall, women represent just 19% of surgeons in the United States — and 22% of full-time surgical faculty.

Black doctors and surgeons comprise 6%  of the field.

Which is why more than 50 surgical department colleagues at Michigan Medicine are working together to help shift the needle.

A group of female surgeons working together in a surgical case at Michigan Medicine.

"I think it all comes down to culture," says Dana Telem, M.D., director of the comprehensive hernia program at Michigan Medicine and an associate professor of surgery. "The higher-ups here didn't say 'Make this happen.' They walked the walk and lived it and breathed and celebrated it. Everyone was engaged.

"Our culture determined how these things move forward."

And the effort isn't limited to Ann Arbor: In May, the Michigan Promise framework was adopted among surgery departments at four other institutions (Brigham and Women's Hospital, Stanford University, University of Alabama at Birmingham and University of Wisconsin-Madison).

Ultimately, each party will share data to gauge successes and ways to engage other hospitals.

Telem and Mulholland explained the Michigan Promise pillars and steps to implementing them:

Building an inclusive environment

Decades of biases — both personal and institutional ones — can affect everything from diversity gaps to systemic practices at any hospital. That has prompted Michigan Medicine to conduct an ongoing educational process and assessment of cultural competence.

Information gathering will come from focused interviews, conversations, surveys and town hall meetings, among other methods. The goal: build a workplace that acknowledges the voices of all surgical employees, including women and underrepresented minorities.

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"There's a whole body of literature that shows workforce diversity correlates with cultural competence," Telem says. "The more diverse a health care team, the higher the likelihood we can provide appropriate care, instill provider trust and improve overall outcomes."

Recruiting with open eyes

Historically, many surgery departments relied on staff referrals and pre-existing pipelines to scout for talent. That practice, intentional or not, excludes scores of qualified candidates.

Michigan Medicine surgery members meet for recruitment discussions.

"It's not enough to say you want to recruit a diverse workforce," Mulholland says. "We now have a rule inside the department: We will not fill any faculty position until we've had at least two on-campus visits by a woman or an underrepresented minority."

Every opening is also posted on job boards hosted by specialty groups to reach a wider talent pool. Those groups include the Society of Black Academic Surgeons, the Association of Women Surgeons and the National Hispanic Medical Association.

Investing in younger faculty

To help new faculty members acclimate and thrive at Michigan Medicine, each receives far more than a mentor. "They're given a mentorship team, not just with surgeons in their discipline but in complementary skill sets" that help foster leadership and growth, Telem says.

A key component is the Faculty & Resident Launch Program, a three-year track that guides faculty through the first few years of practice (and residents during their academic development time) to develop performance aspects critical for success and well-being.

Another effort is an exchange that allows assistant professors to teach and learn at other U.S. institutions for several days. "It accelerates their careers and connects them to smart people early in their careers," Mulholland says.

Finally, plans are in motion to help rigorously prepare all new faculty to achieve promotion to associate professor and full professor ranks. The multi-departmental effort also will examine barriers to advancement and how they affect women and underrepresented groups in surgery.

Establishing paths to leadership

Innovative strategies are shaking up past practices that might once have singled out only a few candidates for consideration.

The Michigan Promise will place early-career faculty in group cohorts to refine their leadership skill sets; another track exists for surgical residents. It also sustains a newly-developed Leadership Development Program for mid-career surgeons designed to develop skills necessary for institutional and professional society leadership.

The objective: to help each surgeon polish his or her professional profile.

"We've made this available to every faculty member," Mulholland says. "Leadership, in our view, is not a top-down activity."

Nurturing medical innovation

In the course of caring for patients, doctors have lots of innovative ideas — a device, an app or a drug application based on lab research. "Many innovations come from the practitioners that see an unsolved clinical problem," Mulholland says.

Those ideas might come to life via the Surgical Innovation Development Accelerator Course, a department-sponsored initiative that helps guide staff-driven concepts that can be considered for the Michigan Innovation Prize, an annual contest worth $500,000 in awards.

The department also institutes a policy known as Directed Sabbatical Time to give faculty to dedicated learning time away from the daily operational tasks of clinical surgery.

"Most programs don't support busy faculty leaving for 6 to 8 weeks," Telem says. "We see it as an investment: You come back with a new skill set. One of our 'mini-sabbatical' surgeons went to Europe to learn a new vascular reconstruction technique. Our patients benefit from that."

Fostering outreach near and far

Learning from surgeons of other ethnic backgrounds — as well as the problems other geographic regions might face — helps a doctor gain perspective and empathy. A key partner in the Michigan Promise is the Michigan Center for Global Surgery, which fosters research, education and clinical exchange programs around the world.

Another bridge is the Doctors of Tomorrow program, a partnership with Cass Technical High School in Detroit. "It's aimed at reaching out to underrepresented minorities who might not have considered college or a career in medicine," Mulholland says.

Crucial, too, is the Women in Surgery group, which connects women surgeons at Michigan Medicine and helps stage an annual conference with guest speakers addressing issues and challenges confronting women as well as personalized coaching opportunities.

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