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Concerns About the Evaluation of Diversity in “Current Perceptions of Diversity Among Head Team Physicians and Head Athletic Trainers”: Response

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Authors’ Response: We first would like to thank the authors who wrote a response to our article for promoting a dialogue in which we can further discuss our methodology to… Click to show full abstract

Authors’ Response: We first would like to thank the authors who wrote a response to our article for promoting a dialogue in which we can further discuss our methodology to research diversity. We applaud and promote publications that provide contextual frameworks and updated recommendations for how to best address race and ethnicity in health care research. Such work represents an increasingly important aspect of communicating about and improving upon racial and ethnic inequities in our field. In addition, had the 2 articles cited above been published before submission of our manuscript, they would have undoubtedly helped inform some of the language utilized therein. Next, we would like to reiterate, as highlighted in the Discussion section of our article, that we fully recognize and appreciate the limitations of our methodology in assigning a single race based on photographs (and surname etymology). In fact, our initial strategy was to gather participant-reported survey data on racial identification, but we elected to switch course after a critically low response rate (5/155) from head team physicians. In order to answer our study question, then, we felt it necessary to utilize an alternative methodology. A study recently published by 2 of the authors of the letter to the editor clearly serves to illustrate how selfreported responses can be very difficult to compile. Even with 100% reporting requirement mandates put into place by large governing bodies, secondhand race assignation by select individuals may be necessary sometimes to gather enough useful data. As was stated in their article (regarding data utilized to draw conclusions about the racial and ethnic diversity of National Collegiate Athletic Association [NCAA] athletic trainers): “At some institutions, individuals may self-identify and report to the coworker responsible for collecting the information. At other institutions, there may be an individual making this determination about their department co-workers.” Just as those authors utilized a data set that included non–self reported data with regard to race/ethnicity to highlight a lack of diversity within a field, we also believe that in the absence of self-reporting, it is still important to report these data. This is what compelled us to earmark our findings as elucidating “perceptions” of diversity among medical personnel within US professional athletics. Interestingly enough, errors that may arise from self-reporting of data on race, ethnicity, and gender were also cited as a limitation in a 2021 article published in the Journal of Bone and Joint Surgery that studied racial, ethnic, and gender diversity in academic orthopaedic leadership. This further highlights some of the challenges associated with writing on this topic. We also recognize that a single race may not completely capture the experience or identity of a multiracial individual, but we chose to structure our data input design after widely accepted reporting tools, such as those used by the American Academy of Orthopaedic Surgeons, which also serves to prevent duplicate entries and facilitate data analysis. The intention of this study was certainly not to reinforce the practice of making assumptions based on visual perception, but rather to be truthful about acknowledging its existence, and in this instance use it to shed light on clear racial, ethnic, and gender underrepresentation within a specific cohort of surgeons and trainers. In our estimation, it would be naı̈ve to suggest that how physicians and trainers self-identify might be more important to injured athletes than how they appear. The purpose of this study was simply to draw attention to the currently disparate levels of racial and gender diversity among professional head team physicians and trainers. Based on a recently announced initiative by the National Football League (NFL) to increase diversity in sports medicine and the fact that one of the senior authors (K.J.J.) was invited by the NFL to a roundtable discussion to discuss these matters based on the premise of this study, it appears to have done just that. Five of the authors of our study self-identify as members of racial/ethnic minority groups (A.J.W.: African American, O.A.: Nigerian and Caucasian, A.D.: Mexican American, K.J.J.: African American, and N.K.P: Indian American). Two of these authors (A.J.W. and O.A.) were responsible for evaluating the race of the medical personnel in our methods. Furthermore, one of our coauthors (K.J.J.) is part of the 16.7% of Black head team physicians in the National Basketball Association. We are subject to the implicit and explicit biases of the patients and athletes we take care of every day based on the color of our skin. We take issues of diversity, equity, and inclusion very seriously, not only from an academic standpoint but also from a personal standpoint. Patients view us, however, through the color of our skin, making assumptions about us regardless of how we selfreport/self-identify. In the absence of self-reported data, we chose to highlight the stark disparities present. There is much work we need to do at the grassroots level in order The Orthopaedic Journal of Sports Medicine, 10(9), 23259671221125463 DOI: 10.1177/23259671221125463 a The Author(s) 2022

Keywords: head team; methodology; race; team physicians; diversity; medicine

Journal Title: Orthopaedic Journal of Sports Medicine
Year Published: 2022

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