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Ruchika Talwar: Hi, everyone. Welcome back to UroToday's Health Policy Center of Excellence. As always, my name is Ruchika Talwar. And today, I'm joined by Dr. Alexandra Tabakin, who is an FPMRS fellow at Northwell Health in New York. She's here today to discuss with us a recent publication that she put out, that has to do with increasing diversity, equity, and inclusion in urology residency recruitment. And what I find really interesting is, the publication actually includes several suggested recommendations on how to improve DEI initiatives from the Society of Women in Urology. Dr. Tabakin, thank you so much for making time to chat with us today. I know this is such an important topic.

Alexandra Tabakin: Thank you so much for having me. So, thank you for having me to discuss our paper entitled, "Increasing Diversity, Equity, and Inclusion in Urology Residency Recruitment: Recommendations from the Society of Women in Urology." So, this project was supported by one of the Society of Women in Urology or SWIU's task forces, on the role of women urologists in advancing diversity, equity, and inclusion, or DEI, in urology residency recruitment.

Our task force was established in 2021 with the primary goals of encouraging grassroots efforts of reducing bias in the application review and interview processes, as well as sharing representative strategies that have been successful. And this paper was one of our task force's multiple initiatives aimed at increasing DEI in the urologic workforce at the recruitment level. As a disclaimer, I do want to clarify that I am not an expert in diversity, equity, and inclusion. The material I'm sharing today represents a summary of various sources put together by our task force.

So, to introduce the topic, the diversity of practicing urologists lags behind the United States population. So for example, in the 2022 AUA annual census, about 12% of urologists identified as women, 5% as Hispanic or Latino, and 2% as Black. And this is quite disproportionate to the national census data in 2020 where the population identified as 51% female, 19% Hispanic or Latino, and 12% Black. And as we know, integrating DEI efforts in healthcare are associated with better patient outcomes. And in order to diversify the urologic workforce, it's critical to recruit and retain diverse talent within urology.

So, to put this paper together, our task force performed a non-systematic literature review and looked at articles from January 2014 through 2024 and compiled our recommendations for best practices for incorporating DEI principles through residency recruitment. Looking at our results, our task force identified three areas where programs can integrate DEI into their recruitment strategies.

So, these include defining a program's mission and values, holistic application review, and carrying out an objective interview process. Regarding defining a program's mission and values, it's really important to create a formal mission and value statement to determine what's important to the leadership and to the members of the program. Where do they want that program to go? And so we recommend identifying attributes that they're looking for in candidates that fit in with achieving those goals. Next is the holistic application review, which is a process for evaluating an applicant's candidacy for residency, by looking at lived experiences and personal attributes, in addition to traditional academic metrics like Step 1 scores.

There's data to support that Step 1 scores don't necessarily correlate with your clinical performance and residency. So, we recommend avoiding using standardized test scores to filter applicants. And other ways to minimize bias in this application review process include blinding reviewers from the applicant's photo, age, gender, things of that nature.

And finally, carrying out an objective interview process is really important. Traditional interviews are susceptible to both conscious and unconscious bias. And so to mitigate some of that bias, programs may want to consider standardized questions and interview rubrics, blinding their interviewers and activity-based assessments. You can also consider providing formal training for interviewers on DEI and minimizing conscious and unconscious bias.

The task force also identified ways to implement DEI into a current residency program. And this is really critical, because it's not enough to just recruit diverse talent, you really have to find ways to maintain it as well. And primarily, that starts by gaining buy-in from program members and leadership. They really need to see DEI efforts as being meaningful and they need to be dedicated to creating that culture of inclusivity. So, to help with this, your program might want to consider establishing a DEI committee or a task force, if it doesn't already have one. And then, this group can develop strategic goals with measurable outcomes, which can help further garner support from leadership and even your institution.

So, specific things a DEI committee can help with include things like bias and diversity training, pipeline projects to start recruitment in urology early on, and providing mentorship for incoming and current trainees, as well as faculty. It is really important to note that often, DEI work goes unpaid, so you may want to consider requesting financial support from leadership, so those who are doing DEI work are fairly compensated for their time. In conclusion, it's really critical, as I mentioned, to diversify the urologic workforce. And this can be done at multiple levels through residency recruitment, but also through systemic efforts to create a culture of inclusivity and retain that diverse talent you're trying to recruit.

At the end of the day though, DEI efforts require a team approach and institutional buy-in. Your group needs to see these efforts as meaningful work that will enhance your culture and healthcare outcomes.

Ruchika Talwar: Thank you so much. I really love how the task force outlined specific actionable steps that programs can take. And I'm curious, on the grand scheme of things, if a program is noticing that perhaps they are falling behind in the diversity of the trainees that they recruit, attract, etc., where would you suggest that they even start? What's the easiest, lowest hanging fruit out of everything you've just discussed?

Alexandra Tabakin: Yeah, so I think, recognizing that you want to increase DEI in your program is the first step. It has to be something that's important to you. And so for people in a residency program or a urology department that find this work to be meaningful and maybe want to educate others in their program or their leadership, a great way to start is really looking at your own institution. A lot of them will have DEI specialists that can come and talk to your group about the importance of this work.

And also, within the urology community. Our community is very small, people are all over social media, Twitter, things like that. And there's a lot of programs out there that have successfully implemented DEI programs and have published their work. It would be a great idea to have somebody from one of these successful programs come and maybe give grand rounds at your program or show their efforts at your institution. And by doing so, they can hopefully convince other people in your program of the importance of this work and certain successful ways that can be implemented to increase DEI in your program.

Ruchika Talwar: Yeah, absolutely. I mean, we're such a collaborative field and we bounce ideas off of each other in other ways. And so, I think DEI initiatives are no different. So, great point there. Let's dig in a little bit to the mission statement of the program. I mean, I think that's great, it's a great way to make sure that you have a vision for the type of talent that you'd like to recruit too. So, can you tell me a little bit about what kinds of things programs should consider when writing their first statement, for example?

Alexandra Tabakin: Yeah, so talking about a mission and value statement. So, the importance behind a mission and value statement is really to gain buy-in from those within your program, the leadership, the members of your residency program or department, and even potentially your institution. We recommend that people from all different levels are involved in creating your mission and value statement. So, whether that includes residents, faculty, administrative support, it's really important to involve everybody and discuss what's important to your group. Are you looking at increasing diversity? Why is that important to you? Are you looking to enhance your patient outcomes? Because healthcare and patient outcomes is one of the primary goals of enhancing in your program.

So, get together with people in your group and figure out what's important to you. And then, when you are looking to do your review of applicants and you're looking at what sorts of attributes you might want, reflect back on your mission and value statements and look at what sorts of things are we looking for in applicants to help achieve those goals.

Ruchika Talwar: Yeah, that's great. I think it keeps everyone on the same track. But more importantly, you're right, it gets everyone aligned as to what the end goal is. You have buy-in from all interested parties, and I just love the fact that you said to include people from all different roles within the department, whether that's trainees, administrative staff, clinical and nonclinical folks. Super, super important.

So, as we wrap up here, Dr. Tabakin, I'm just wondering, what are your final words to the urologic community? What are the big takeaways from this?

Alexandra Tabakin: I think, the biggest takeaway is really realizing that the health of our population, in terms of the field of urology, is closely tied to the diversification of our workforce. There's a lot of data out there to support that healthcare outcomes improve when the patients are reflected by the population taking care of them. So, patients tend to do better when treated by physicians or medical staff that look like them, and that may be because they trust them more or because those types of doctors are more likely to listen to those types of patients. So, for those looking to increase or enhance their DEI efforts, it really is all about enhancing patient care and healthcare outcomes.

Ruchika Talwar: Yeah, great points. I think it's often easy to get lost in the meaning of why these efforts are so important, and we have great evidence to show us that diversifying our workforce does actually provide better patient care. So, I couldn't have said it better myself.

Thank you so much for taking the time to share your task force's recommendations with the UroToday audience. I know I learned a lot and I'm sure our audience did as well.

Alexandra Tabakin: Thank you so much for having me.

Ruchika Talwar: And to our UroToday audience, we'll see you next time.