Browsing by Author "Gonzalez, Andrew"

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    Investigating Unconscious Race Bias and Bias Awareness Among Vascular Surgeons
    (medRxiv, 2024-06-05) Howard, Kerry A.; Witrick, Brian; Clark, Ashley; Morse, Avery; Atkinson, Karen; Kapoor, Pranav; McGinigle, Katharine L.; Minc, Samantha; Alabi, Olamide; Hicks, Caitlin W.; Gonzalez, Andrew; Cené, Crystal W.; Cykert, Samuel; Kalbaugh, Corey A.; Surgery, School of Medicine
    Background: Implicit bias can influence behavior and decision-making. In clinical settings, implicit bias may influence treatment decisions and contribute to health disparities. Given documented Black-White disparities in vascular care, the purpose of this study was to examine the prevalence and degree of unconscious bias and awareness of bias among vascular surgeons treating peripheral artery disease (PAD). Methods: The sampling frame included all vascular surgeons who participate in the Vascular Quality Initiative (VQI). Participants completed a survey which included demographic questions, the race implicit association test (IAT) to measure magnitude of unconscious bias, and six bias awareness questions to measure conscious bias. The magnitude of unconscious bias was no preference; or slight, moderate, or strong in the direction of pro-White or pro-Black. Data from participants were weighted to account for nonresponse bias and known differences in the characteristics of surgeons who chose to participate compared to the full registry. We stratified unconscious and conscious findings by physician race/ethnicity, physician sex, and years of experience. Finally, we examined the relationship between unconscious and conscious bias. Results: There were 2,512 surgeons in the VQI registry, 304 of whom completed the survey, including getting IAT results. Most participants (71.6%) showed a pro-White bias with 73.0% of this group in the moderate and strong categories. While 77.5% of respondents showed conscious awareness of bias, of those whose conscious results showed lack of awareness, 67.8% had moderate or strong bias, compared to 55.7% for those with awareness. Bias magnitude varied based on physician race/ethnicity and years of experience. Women were more likely than men to report awareness of biases and potential impact of bias on decision-making. Conclusions: Most people have some level of unconscious bias, developed from early life reinforcements, social stereotypes, and learned experiences. Regarding health disparities, however, these are important findings in a profession that takes care of patients with PAD due to heavy burden of comorbid conditions and high proportion of individuals from structurally vulnerable groups. Given the lack of association between unconscious and conscious awareness of biases, awareness may be an important first step in mitigation to minimize racial disparities in healthcare.
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    Managing Central Venous Access during a Healthcare Crisis
    (Elsevier, 2020-07-15) Chun, Tristen T.; Judelson, Dejah R.; Rigberg, David; Lawrence, Peter F.; Cuff, Robert; Shalhub, Sherene; Wohlauer, Max; Abularrage, Christopher J.; Anastasios, Papapetrou; Arya, Shipra; Aulivola, Bernadette; Baldwin, Melissa; Baril, Donald; Bechara, Carlos F.; Beckerman, William E.; Behrendt, Christian-Alexander; Benedetto, Filippo; Bennett, Lisa F.; Charlton-Ouw, Kristofer M.; Chawla, Amit; Chia, Matthew C.; Cho, Sungsin; Choong, Andrew M.T.L.; Chou, Elizabeth L.; Christiana, Anastasiadou; Coscas, Raphael; De Caridi, Giovanni; Ellozy, Sharif; Etkin, Yana; Faries, Peter; Fung, Adrian T.; Gonzalez, Andrew; Griffin, Claire L.; Guidry, London; Gunawansa, Nalaka; Gwertzman, Gary; Han, Daniel K.; Hicks, Caitlin W.; Hinojosa, Carlos A.; Hsiang, York; Ilonzo, Nicole; Jayakumar, Lalithapriya; Joh, Jin Hyun; Johnson, Adam P.; Kabbani, Loay S.; Keller, Melissa R.; Khashram, Manar; Koleilat, Issam; Krueger, Bernard; Kumar, Akshay; Lee, Cheong Jun; Lee, Alice; Levy, Mark M.; Lewis, C. Taylor; Lind, Benjamin; Lopez-Pena, Gabriel; Mohebali, Jahan; Molnar, Robert G.; Morrissey, Nicholas J.; Motaganahalli, Raghu L.; Mouawad, Nicolas J.; Newton, Daniel H.; Ng, Jun Jie; O’Banion, Leigh Ann; Phair, John; Rancic, Zoran; Rao, Ajit; Ray, Hunter M.; Rivera, Aksim G.; Rodriguez, Limael; Sales, Clifford M.; Salzman, Garrett; Sarfati, Mark; Savlania, Ajay; Schanzer, Andres; Sharafuddin, Mel J.; Sheahan, Malachi; Siada, Sammy; Siracuse, Jeffrey J.; Smith, Brigitte K.; Smith, Matthew; Soh, Ina; Sorber, Rebecca; Sundaram, Varuna; Sundick, Scott; Tomita, Tadaki M.; Trinidad, Bradley; Tsai, Shirling; Vouyouka, Ageliki G.; Westin, Gregory G.; Williams, Michael S.; Wren, Sherry M.; Yang, Jane K.; Yi, Jeniann; Zhou, Wei; Zia, Saqib; Woo, Karen; Surgery, School of Medicine
    Introduction During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns and outcomes of these vascular access teams during the COVID-19 pandemic. Methods We conducted a cross sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. In order to participate in the study, hospitals were required to meet one of the following criteria: a) development of a formal plan for a central venous access line team during the pandemic, b) implementation of a central venous access line team during the pandemic, c) placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice, or d) management of an iatrogenic complication related to central venous access in a patient with COVID-19. Results Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2,657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis® catheters and non-tunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of hospitals. Less than 50% (24, 41%) of the participating sites reported managing thrombosed central lines in COVID-patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). Conclusions Implementation of a dedicated central venous access line team during a pandemic or other healthcare crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed healthcare system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained ICU, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future healthcare crises.
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    Understanding and finding opportunities for inclusive mentorship and sponsorships in vascular surgery
    (Elsevier, 2021) Quiroga, Elina; Gonzalez, Andrew; Newhall, Karina; Shalhub, Sherene; Surgery, School of Medicine
    Deliberate efforts are needed to address the lack of diversity in the vascular surgery workforce and to correct the current scarcity of diversity in vascular surgery leadership. Effective mentorship and sponsorship are crucial for success in academic surgery. In the present report, we have explained the importance of mentorship and sponsorship relationships for surgeons historically underrepresented in medicine, discussed the unique challenges faced by them in academic surgery, and provided a practical framework for fostering intentional and thoughtful mentor and sponsor relationships to nurture their careers.