LAUSR

I n this issue of Annals of Surgery, Stewart et al 1 summarize the events and discussions that occurred during a retreat held by the American Board of Surgery (ABS) in September 2020. The goal of this retreat was to ‘‘address racism in surgery,’’ and more specifically, ‘‘define racism; identify the impact of racism on surgical training, professionalism, and patient care; and initiate a framework for the ABS to address racism in surgery.’’ While working towards these goals, the group held discussions on patient outcome disparities, clinician promotion/burnout, and why diversity and anti-racism matter specifically within the realm of surgery. Although this retreat is the first of its kind for the ABS, the group has previously implemented some changes in an attempt to reduce racial disparities in our field. For example, all examiners and staff for the oral qualifying exam (QE) must now undergo implicit bias training, and the exam itself has been more standardized to reduce implicit bias in case presentations. Additionally, the ABS is collecting more thorough demographic data from examinees to allow for explicit tracking of examination outcomes by race and ethnicity, amongst other variables. At the conclusion of their retreat, the ABS committed to the creation of a dedicated task force to more formally address these issues moving forward. Although the actions and reflections shared by the authors are encouraging, we posit that this is only the starting point for what will need to be a momentous and enduring effort by our field to reverse the harm already done to our patients and surgical colleagues. Furthermore, the ABS must maintain accountability as pertains to these various equity efforts. We would like to commend the ABS for holding this retreat and undergoing what was likely a challenging and novel form of self-reflection for the group as a whole. Our nation has seen a great reckoning with racism over the past several months, and these conversations can be awkward or confrontational. However, while uncomfortable, these conversations can lead to an important shift in perspective on what it means to be truly equitable. The act of naming racism and its impact on both patients and clinicians is a critical act by the ABS. By acknowledging that racism exists throughout ‘‘surgical leadership, training, and practice,’’ the ABS brings a voice to those impacted by racism and legitimizes productive conversations, analyses, and interventions to combat it. For example, the authors relay statistics presented at the retreat by Dr. Robert S. D. Higgins about the disproportionate representation of Black men and women at all levels of medicine, and how this can be at least partially explained by implicit bias and institutional racism. Rather than framing underrepresentation as an accidental oversight, the ABS is taking agency and highlighting these data as a critical deficiency in our field that can no longer be ignored or tolerated. However, just as in clinical medicine and research, there is always more work to be done in racial justice and equity efforts. We must treat both patient health disparities and clinician underrepresentation as public health crises. As cited by the authors, data unequivocally shows that morbidity and mortality disproportionately impact minority patients as compared to their White counterparts. The Institute of Medicine alerted healthcare workers to racial inequity in medicine nearly two decades ago, yet we have not made significant progress in this regard. Unfortunately, this nearly 20-year delay is consistent with the rates of adoption of evidence-based clinical medicine. As demonstrated by the COVID-19 pandemic and Operation Warp Speed, it requires an immense amount of funding and infrastructure to rapidly address a public health crisis. Without these resources, racism and other social determinants of health will continue to insidiously harm our both our patients and our colleagues. Fortunately, there already exist some efforts to mitigate the impact of racism on surgery. As suggested at the retreat, the first step in such a process might be to further diversify the board. Although this has certainly been a priority in the past, traditionally board members have been selected from the nominations of participating surgical societies; in recognition that most of these candidates are academic surgeons, an additional group of at-large directors have been elected directly by the board itself. In this context, it would seem appropriate to ask the societies to make diversity a major