BACKGROUND:Across surgery, marginalized individuals experience worse postoperative outcomes. These disparities stem from the interplay between multiple factors. METHODS:We introduced a novel framework to assess the role of barriers to access and bias in surgical complications (the uChicago Health Inequity Classification System, CHI-CS) in the setting of morbidity and mortality conference and assessed impact through pre and post implementation surveys. RESULTS:Access and bias were related to surgical complications in 14 ​% of cases. 97 ​% reported enhanced M&M presentations with the grading system, and 47 ​% reported a change in decision-making or practice style. Although post-implementation response rate was low, there were improvements in self-reported confidence and comfort in recognizing and discussing these issues. CONCLUSIONS:Implementation of the CHI-CS framework to discuss bias and access to care positively impacted the way providers view, discuss, and process health inequities.

Introduction: Studies have suggested that experiences of gender and racial discrimination are widespread among surgeons and surgical residents. This study examines the relationship between experienced microaggressions and traumatic stress.Methods: A one-time, deidentified survey was distributed over email to academic surgical societies. The survey consisted of 35 items including questions on prevalence of microaggressions, perceived job impacts as well as a shortened version of the Trauma Symptoms of Discrimination Scale. Chi-square tests and an independence test for trends were utilized to determine significance.Results: We collected data from 130 participants with majority (81%) having experienced microaggressions in the workplace. On measures of worry (P < 0.001), avoidance (P = 0.012), anxiety (P = 0.004), and trouble relaxing (P = 0.002), racial/ethnic minority surgeons and trainees demonstrated significantly higher scores. With perceived job impacts, significant agreement was seen with occurrences of working harder to prove competence (P = 0.005), gaining patient confidence (P < 0.001), reduced career satisfaction (P = 0.011), work-related negative talk (P = 0.018), and burnout at work due to microaggressions (P = 0.019). Among participants who underwent behavioral modifications, female surgeons were more likely to change their nonverbal communication styles (P < 0.001) and spend more time with patients (P < 0.001).Conclusions: Experiences of microaggressions are associated with increased anxiety-related trauma symptoms in racial/ethnic minority surgeons and surgical trainees. Additionally, these experiences of microaggression can influence job satisfaction, burnout, career

As the use of endovascular aneurysm repair (EVAR) increases, anatomic constraints remain a challenge. In this case report, we describe the use of intravascular lithotripsy to facilitate EVAR in a patient with a severely calcified and stenotic aortic bifurcation. Future applications of intravascular lithotripsy could help expand the use of EVAR to patients with severely stenotic vasculature and optimize outcomes in the treatment of infrarenal abdominal aortic aneurysms.

To the Editor: After hearing my mentor speak on her journey as a Black woman in surgery, I remarked to her about how surprising it was to hear that she was the first Black person to graduate her integrated residency in the mid-late 2010s. Her response stopped me in my tracks: "Don't worry, you'll also be considered a pioneer." The problem is I do not know if I want to be a pioneer—at least in a field that may not provide the needed support to carry the load of being "one of the firsts." Every Match Day, we praise and celebrate the few individuals who are given the title of "First ____ in specialty X at Institution Y." But we fail to acknowledge the psychological toll of being "a first," or in other words, being the only one like yourself in the workplace. Often, within the same conversation celebrating history, we are told of the needed additional work to stay at the same level as our peers—told that we will need to put in more hours, perform against stereotypes, and at best, just keep our heads down. For many, this emotional and psychological toll looks like struggling in a system that they may grow to dislike but must learn to survive. In the hopes of creating a more inclusive workplace, the struggle does not need to be experienced alone; it takes a village to create a sense of security for one to develop and do more than just survive. Coming into medical school, I never thought that I would be able to find a mentor who believed that I could take ownership of my work and that I could get through my everyday life as a medical student. In a field where affirmations are rarely given, it has meant a great deal to hear the words "you've got this" in times when I have felt the most unsure of myself. While fortunate in experiences with my mentor, I know that being "one of the first" means that I cannot have only her in my corner. As racially underrepresented women, we need our mentors, but we also need our sponsors, our coaches, and our advocates. It should not be up to the already limited pool of physicians who are Black, indigenous, and other people of color to sustain the increasingly diverse physician workforce. We need intentional mentorship and support from allies to create this environment. S imi Ogunnowo Medical student, University of Chicago Pritzker School of Medicine, Chicago, Illinois; email: [email protected]Ifeoma IkedionwuMedical student, University of Chicago Pritzker School of Medicine, Chicago, Illinois

Morbidity and Mortality (M & M) conferences have been a mainstay of physician education, patient care analysis, and systems improvement for more than a century. The M & M conferences began with Ernest Codman’s “End Results System” to provide objective quality assessment. This system used the clinical history and outcomes of patients to systematically review adverse outcomes and identify errors.1 The Accreditation Council for Graduate Medical Education (ACGME) defined 6 determined core competencies—interpersonal and communication skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and systems-based practice.

Objective: Our objective was to identify factors associated with COVID-19 vaccination in trauma patients and to provide an opportunity for patients to engage in conversations about vaccination. Background: The trauma surgery service offers a unique opportunity to promote preventative health interventions in hard-to-reach populations. Methods: Trauma inpatients in Chicago, IL were recruited for this mixed-methods study from February 2022 to April 2022. Participants completed a survey on demographics, COVID-19 vaccination status, and Experiences of Discrimination Scale adapted for medical settings. Differences between vaccinated and unvaccinated patients were analyzed using the Wilcoxon-rank sum test. A semistructured, qualitative interview was completed. Qualitative data was transcribed and analyzed using Grounded Theory Methodology. Results: Fifty-eight trauma patients were surveyed, representing 88% of patients approached. Only 23 (40%) patients reported full vaccination to COVID-19. Previous vaccination (at least 1 dose) was associated with greater concern for COVID-19 (OR 3.47, 95% CI 1.987–6.964, P < 0.001) and higher income (OR 1.21, 95% CI 1.02–1.44, P = 0.03). Higher Experiences of Discrimination Scale scores were associated with decreased likelihood of prior vaccination (OR 0.97, 95% CI 0.95–0.99, P = 0.04). On qualitative analysis, recurrent themes included vaccination motivated by either community-based or personal health-related values, and disinterest in vaccination based on perceived low need or skepticism of experimentation. Fifteen patients (26%) eligible for a vaccine dose consented to onsite vaccination after the survey. Conclusions: Trauma patients who have experienced more discrimination in medical settings have lower rates of COVID-19 vaccination. Vaccination rates in our population were over 2 times lower than citywide rates, but admission to the trauma service can increase comprehensive care.