and Anna for inviting me to talk. I hope you get something out of this and learn something. So my disclosures are not appropriate for this. So basically, what is the problem? Well, the problem is the lack of females in orthopedics, as you all know, and underrepresented minorities. About 50% of medical students are female, 14% of orthopedic residents, and 7% of academy fellows. Less than 1% of female medical graduates go into or pursue an orthopedic residency, and only about 9% of orthopedic faculty are women. So is it progress? Well, you look at this slide and you go, oh, the number of women candidates, women fellows have increased, but when you look at the overall rate of women in orthopedics, as you can see, it has remained very steady for these 10 years. So the number of female residents increased only 7% over the past 19 years, if we keep going at this rate. By the year 2100, we will only be less than 30%, and that's with no changes. And that's, what, just a few years from now. So what about other specialties? Are they having the same problems? When you look at orthopedics here, over these 10 years, we gained a few percentage, but you look at things like thoracic surgery, which went from 11% to 20%, what are they doing differently that we aren't doing to attract the women? What about underrepresented minorities? African Americans are 4.1% of residents, Hispanics 2.7% of orthopedic residents. For every one African American applicant, there are 13.5 white applicants. For every Latino applicant, 14.1 white applicants. This is another interesting slide showing the percentage of people that get in that apply. So for whites and Asians, about 70 to 80% of them get in that apply, and this is consistent over these years. If you look at underrepresented minorities, which are down here, much lower acceptance rates, and also it hasn't changed. You wanna see this zipping up if we're really looking at this problem with the number of applicants. So the problem has been looked at by the Royal Australasian College of Surgeons. It had been a survey in 2015, and about 49% of their surgeons said that they had either experienced discrimination, bullying, sexual harassment, or harassment. And greater than 50% of surgeons in the academies work environment culture survey in 2018 felt that they'd experienced either discrimination or bullying, and 84% of females, 85% of blacks and Hispanics said that they'd had experienced one of these things. The National Academy of Sciences looked at medical students in general, and 50% of medical students reported harassment. The climate was the number one predictor of whether or not these people would be harassed in their opinion. So we're gonna have a talk later about bias. That's another problem, I'm not gonna go into it. I think Leah's gonna talk about that later. So it is there, it is a problem. So what is the progress? So the Royal College of Australasia, which is Australian Asia, obviously, has this really weird symbol here. But these people actually are coming up with some ideas. So they came up with 42 recommendations to be done over the next five years, including culture change, mandating education, how to manage complaints, and a diversity action plan to increase the number of women in leadership positions. So what about our academy, what are they doing? So with their survey that they did in 2018, they had people make suggestions from that survey, and 70% of the people who took the survey recommended they increase the leadership, they increased leadership in department heads and supervisors to understand the diversity problem, and 50% also recommended that there was increased support and resources to handle situations which they have been in. Surgeon involvement is actually hugely progressive over the last five to 10 years. There have been multiple articles now in Journal of Academy, the Core, AOS Now, that people are actually doing some research on this problem to try to get numbers and to find the problem, and to possibly even propose some solutions. Our academy itself is actually, in their 2019 strategic plan, goal number three of their strategic plan is to evolve the culture and governance of the academy board to become more strategic, innovative, and diverse, and they're having metrics to measure this. They also brought about the Diversity Advisory Board, which has been tracking these type of things, and the things they speak about are recruitment of unrepresented minorities and women, transparency, and enhanced retention of people within the groups within the academy, and to promote the culture that is supportive to these people. I was fortunate to, as a part of Anna's Diversity and Inclusion Task Force, sit in on some of their meetings, and it's pretty cool. This is a typical, I know you can't read it, but it's a typical dashboard in which they're looking at, especially on the site over here, whether or not they're making progress, whether these things are at risk, but these are goals that they've defined, and they're keeping track with their meetings. They meet quarterly to look and see which of these things are actually being accomplished. This is pretty interesting, too, on their dashboard. They look at, year by year, what percent of females are on the board, what percent of females are doing committee leadership, and what percentages are in committee membership, and it's a percentage by year, and they're tracking this, which is, again, increasing awareness and trying to do something about it. So they adopted a policy also in 2018. They adopted their anti-discrimination and anti-harassment policies, and they adopted an opinion policy on sexual harassment, and these are on the Academy website. They instituted something called the Faces in Orthopedics. It's a campaign to encourage conversations around diversity, equality, and inclusion, and this was, again, in 2018. I wanna talk a little about the progress that we've made in ANA, and I wanna shout out to Brian Cole, who actually started the task force to try to look at the problem within ANA in specifics, and Don Buford and I chair this committee, and I want a big shout out to all my committee people who are also on the committee, many of which are forum members, so I appreciate all the work that they've accomplished. The charges of the task force are many. We brought these up before we started the task force, which tried to give us some goals, and just a few of the things from this that we have accomplished. We did get an ANA diversity statement, which, again, I'm not gonna read the whole thing. It's on the ANA website, but basically talks about committing to diversity and celebrating diversity. The annual diversity lecture, which was chosen by the committee, diversity lecturer today, which was Rick Ryu, that has already been implemented. We are also, at the next ANA meeting, going to award a diversity award, which is the best accepted research paper by an underrepresented minority person, and so that award will be given next year at our annual ANA meeting. So one of the problems we've had, though, and we realized, is the fact it's really hard to identify the issue of how diverse or non-diverse ANA really is, and this just has to do with when you fill out, when ANA members would fill out their applications, there weren't categories for specifying whether you were an underrepresented minority or female. So we're working back and going through the ANA membership directory to try to find out exactly what the percentages are of the people so we can track it a little bit better. And the other thing that ANA realized is the fact that a lot of the problems are occurring before people even get into, it's not just getting into ANA, it's getting people, women, into orthopedics, and then underrepresented minorities into orthopedics. So we are, the Orthopedic Learning Center is starting a course for first year, med students between first and second years to go and play in the lab and learn orthopedics. So starting with early med school to try to encourage women to go into orthopedics and technically into sports medicine or arthroscopy. The other thing I think we've made great strides in is mentoring. The Nth Dimension PERI initiative, both pipeline-type programs, which have been super in trying to get younger women into, interested in orthopedics. Recognition has also made progress. The HeForShe Award for RJOS, the diversity lecture, as you saw earlier, from Rick Ryu, and the Academy always has had a diversity award for quite a long time. So I think recognize the people who do make a difference in diversity is very important. Here's another awesome list that is growing. It is the list of women who are chairs of orthopedic programs. And this list is continuing to grow. Again, progress, thank you. The other thing we have is a lot more support groups. The Gladden Society, Ruth Jackson, Latino orthopedic surgeons have been around. These are academy-sanctioned smaller groups. These are groups that have kind of morphed off that are not academy-sanctioned, but obviously are great support groups for women. PASNA, Foot & Ankle, and OTA have also kind of subdivided off and recognized, spent time to recognize women within their profession, which, you know, kudos for. Social media, I think, has been a huge support for a lot of people. The Women of Orthopedics Facebook page is a closed group. So I think the women, any of you who have been on that, you know, it's a nice place to kind of talk in a larger sense and discuss things. Speak Up Ortho was just recently founded by Nancy N. Shippey and Jen Weiss and some others. And it is a Twitter and Facebook, which if you haven't gone to it, this is an open group that you can go look at. And if you haven't looked at this, there are some pretty sad stories on there. So if you aren't aware of some of the things that women have been going through, it's a great place to look. And in the first few weeks when they put this out, there were greater than 400 personal stories that went up by residents and women in orthopedics about their particular personal stories and things they'd been through, just they'd wanted to tell their stories. But there's some pretty amazing stories on there. The other thing I wanna shout out to Ruth Jackson and Alana Munger, who have a podcast, She Can Fix It. And RJOS has been supportive of that. And I think it's an awesome podcast, again, trying to bring up women within orthopedics. The other progress, recognizing bias. The implicit bias thing, most people obviously aren't aware of it because it's implicit bias. But a lot of places are now using this implicit bias test just to see how prevalent it is within their population. So is there progress in diversity? Yes, there definitely has been progress in diversity, but there's still a long, long way to go. But no road is long when dreams are big and sky is the limit. Thank you.

lack of diversity

orthopedics

underrepresentation

females

minorities