In a specialty that remains predominantly white and male-dominated, the way medical training programs present themselves can be influential to bringing in more underrepresented talent, spine surgeon Miracle Anokwute, MD, said.
Dr. Anokwute, of Indianapolis-based Goodman Campbell Brain and Spine, discussed the factors still affecting spine surgeon diversity gaps and how they can be addressed.
Note: This conversation was lightly edited for clarity.
Question: Can you name any mentors or experiences that really affected your work today and your approach to patient care?
Dr. Miracle Anokwute: I had a few mentors going through the process of becoming a neurosurgeon, spine surgeon. These mentors really helped shape my practice and the type of a surgeon that I am. Namely, Scott Shapiro, MD; Jean-Pierre Mobasser, MD, and Nate Shaw, were some of my mentors early during my test to become a neurosurgeon. The things I gained from each one of them was the idea of a surgeon being very much available and affable and having the tools that allow you to take great care of patients. Those were very key for me in my development as a neurosurgeon.
Q: When it comes to diversity in the spine field, what does that picture look like today, and how does it compare to patient populations that you’re serving specifically?
MA: From the patient population standpoint we serve patients from all backgrounds, but from the spine surgeon standpoint there’s still quite a gap and unfortunately, in medicine overall. There’s a significant gap in the U.S. when it comes to diversity from the physician standpoint versus the patient population standpoint, and that gap is something that just keeps growing. It’s even worse for sub-specialties since there is such a lag in training that prevents that diversity barrier from being overcome. For example, it takes about three to four years to train an internal medicine doctor through residency. And for neurosurgery it’s a seven year residency program. Then if you do a fellowship, that’s an additional year. That’s eight years to go from graduating medical school and becoming a full-fledged physician practicing in the community, and so that lab time in these sub-specialties really brings about a dynamic where there is again, significant disproportion when it comes to physicians from diverse backgrounds treating patients from diverse backgrounds.
Q: What are some of the other barriers facing underrepresented students? How can these things be addressed on the practice level and more broadly?
MA: Some of those include a lack of available mentors for these students that are interested in neurosurgery. Lack of access is really the biggest key, and when it comes to diversity and neurosurgical training, there are few formal mentorship programs out there to allow for students who are interested from diverse backgrounds to be able to shadow and interact with neurosurgeons and spine surgeons. This lack of access is a barrier for underrepresented minorities and also for women to enter the pipeline to become neurosurgeons.
There’s also a barrier of what we call “fit” when it comes to training in subspecialties. There’s a certain fit that gets described by surgeons and programs, and that fit is important because it’s part of a cultural fit. If you’re an underrepresented minority there might be an unconscious bias when it comes to a cultural fit for a program, and that can be a barrier for a trainee. One of those things that could potentially improve that barrier is to understand that that fit can be quite subjective. Instead of looking at the fit, look at the ability of that student or trainee to meet certain metrics or objective data. Cultural fit is important, but I don’t think that it’s all that is needed to get somebody in the pipeline for neurosurgery.
Q: Is there any common language you see across programs that you’d like to see updated?
MA: I think it’s important to bring a language of values. I think performance and a language of performance is important. It’s a better language than “cultural fit” because values are things that you can see objectively. Performances are things that you can do objectively. Identifying fit is a little bit harder and very much subjective. If you come from a background that is either an underrepresented minority or saying that you’re a woman going into a specialty that is very much male-oriented or does not have a significant amount of underrepresented minorities in it, from the cultural fit standpoint, you already have a barrier. Understanding the values and performance metrics for students is going to be a better way to phrase that instead of a cultural fit.
Q: Are any programs or initiatives that you’ve worked with that have worked in these respects?
MA: I’m a member of the American Society of Black Neurosurgeons. We have a mentoring program with medical students, residents and young attendees like myself starting practice. It’s a mentorship ladder where you have a neurosurgeon who’s been in practice for several years mentoring a young neurosurgeon who’s also mentoring a young resident who’s mentoring a young medical student who’s mentoring an undergraduate student. That kind of a pipeline allows for a shared space where it allows the mentors and mentees to interact with each other. I think that that’s a great program that does help break those barriers.
