RUTHFULLY YOURS

America’s surgeons are not woke enough, according to the American College of Surgeons (ACS). Such is the message of the leadership to fellows of the ACS. In a previous column on this site, I described how the ACS doubled down on anti-racism and DEI at its annual Clinical Congress in Boston this October with courses in its educational program for surgeons. To underscore its ongoing commitment to anti-racism and DEI, the ACS just launched its DEI Toolkit and continues to promote this ideology as though its life depended on it.

To say this is puzzling is an understatement, especially given recent trends. Diversity, equity, and inclusion departments throughout the country are being shut down, DEI administrators are being handed their walking papers, and the ideologies of anti-racism and DEI are being increasingly recognized for their illiberal, divisive, and fraudulent nature. Take anti-racism. Even Ibram X. Kendi, who coined the term, is incapable of defining this in a coherent manner. When asked to define anti-racism, he offered: “Antiracism is a collection of antiracist policies leading to racial equity that are substantiated by antiracist ideas.” This is a classic circular argument that no critically thinking person would accept.

And, yet, the American College of Surgeons has grabbed onto the ideology of structural racism and just won’t let go. After embracing anti-racism and DEI in 2020 and promoting the ideologies at the 2023 annual Clinical Congress in October, the leadership of the ACS is seeking to further embed anti-racism and DEI in the college and into surgical practices. The tool kit is an exhaustive, some might say exhausting, compilation of everything related to pushing the narrative of systemic and structural racism as the source of disparities including minority representation within the ACS and clinical outcomes in minority surgical patients. If it promotes anti-racism and DEI, it is in the tool kit. Time and space do not permit a thorough dissection of the entire tool kit, but a few examples will suffice to demonstrate the profound ideological tone.

The tool kit continues to promote the unbelievably toxic concept that racism infuses surgical care and leads to worse outcomes in minority patients. It specifically references the example of a study purported to show that survival of newborn black babies is better if the doctor is black. Never mind that a critical review of this study showed it to be “catastrophically flawed.”

The tool kit repeatedly promotes the use of the Implicit Association Test as a means of assessing racial bias in decision-making and practice despite the fact that the test has been repeatedly and conclusively shown to be “without psychometric evidence of construct or predictive validity.”

The ACS has historically been at the forefront of advancing the science and practice of trauma care using time-tested, evidence-based methods of research and application. Trauma is a major source of death and disability in the U.S., with an estimated shortage of 2,400 trauma surgeons at the present time. Rather than focusing on this acute need, the ACS tool kit is expanding, and diluting, “trauma” care to include controversial practices such as appraising patients for adverse childhood experiences and engaging in trauma-informed care. Both of these are based on disputed concepts and do nothing to advance a surgeon’s ability to treat trauma patients.

The list of topics covered in the organization’s DEI Toolkit includes every element that supports the fiction of systemic racism: intersectionality, microaggressions, implicit bias, allyship, active bystander, white privilege, and more. Perhaps the most egregious aspect of the tool kit is its relentless persistence of referring to surgeons and patients by their identity groups. If a surgeon does not take into account a patient’s identity group in caring for them, the tool kit asserts that surgical care and outcomes will be compromised. Like all group identity–based practices, the tool kit treats each group, e.g. blacks, as though they were homogenous. All blacks, for example, are victims of oppression and systemic racism, according to this thinking. The traditional tenets of Hippocratic medicine, which focus on the individual in front of the physician, have been, for all intents and purposes, abandoned. Any disparity in outcomes of care of minorities is proof of racial discrimination.

One of the most troubling aspects of anti-racism and DEI is the effect on surgical education. Surgery is a very difficult, demanding profession that takes years to master. There is a finite amount of time in residency training to mold a competent surgeon from a fumble-fingered intern. To assume that we can continue to turn out excellent surgeons and simultaneously burden surgical education with the degree of time-consuming indoctrination in anti-racism and DEI demanded by the ACS tool kit is, at best, foolish and futile, and, at worst, dangerous to our patients. I have spoken to many of my surgical peers, and we agree that we are already seeing an erosion of quality in surgery, with many programs turning out surgeons who are not ready to practice independently. I have spoken to surgical residents who report a sense that they are not getting the necessary hands-on clinical and surgical experience to feel confident, while being simultaneously tasked with assimilating and regurgitating anti-racist and DEI ideology.

The mission of the ACS is “To Serve All With Skill and Fidelity.” In embracing anti-racism and DEI and devoting precious time and resources to such distractions as the DEI Toolkit while real-world surgical needs remain unmet, the American College of Surgeons is failing in that mission. It continues to do this at its peril.