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The Deepening Significance of DEI

By Cesar J. Bravo, MD

Diversity is often defined as the presence of differences within a given setting, and Equity is frequently defined as the process of ensuring that processes and programs are impartial and fair. Finally, Inclusion is often defined as the practice of ensuring that people feel a sense of belonging in the workplace or in a field of specialty. Over the years, the significance of these words has deepened for me.

Growing up on the Caribbean Island of Puerto Rico, I was fortunate enough to experience inclusion and equity within a diverse group of people.  Puerto Rico, “La Isla del Encanto”, is made up of a collage of people with multiple ethnicities in which diversity is the norm. The University of Puerto Rico Orthopedic Program reflected this aspect of the island’s culture. As the sole Level I trauma medical center in the Caribbean, diverse surgical residents were taught to treat patients from all walks of life and socio-economic backgrounds, fairly and impartially.

I was blessed with mentors in hand surgery also committed to inclusion and equity. At the hand surgery fellowship at Mayo Clinic Rochester, MN, hand surgery “consultants”, all with different backgrounds and training, instilled the fundamentals of hand surgery to this young surgeon in an inclusive way. I still remember my first day of surgery as a new hand fellow. While dissecting a revision Dupuytren’s contracture adductor digiti quinti cord with significant altered anatomy, one of my mentors, Allen T. Bishop, M.D., whispered in my ear, “Look around—you’re operating at the Mayo Clinic”. In this foreign place, I truly felt included for the first time as multiple visitors in the operating theater watched this master surgeon take me through this case with a newly purchased set of loupes. Without my mentors’ and Mayo Clinic’s commitment to equity, I could not have become the surgeon I am today.

To say that there haven’t been any bumps in the road would be misleading. We have yet to eliminate all the difficulties that face minorities in the specialty we love. Furthermore, I would be remiss not to share my journey without the mention of experiences of implicit bias. Yes, they did and still do exist. However, the impact of the individuals who grasp the type of environment for which we are striving is my focus. Now, I have the privilege to lead an inclusive hand surgery fellowship program in Roanoke, VA where we train hand fellows from different backgrounds with a core of culturally diverse talented faculty. The ability to give back to a profession that has given me so much is an honor.  

The reason diversity, equity, and inclusion are more significant than the definitions I started with is this: a commitment to these values made the profession I love a possibility. Of course, it is vital for the growth of the ASSH to draw under-represented minorities into our field. However, it is also vital for those individuals aspiring to join the profession we love—some of which, without our efforts, will meet unnecessary and inequitable resistance. Those of us from under-represented communities and backgrounds need to pave the way so inequitable expectations no longer exist for our future colleagues. We all need to continue working toward inclusion for future members so that ASSH can stand as a shining example of equity, diversity, and inclusion. 

Cesar J. Bravo, MD
Program Director, Virginia Tech Carilion School of Medicine Hand Fellowship
Hand and Upper Extremity Surgery
Brachial Plexus and Peripheral Nerve Surgery
Associate Professor, Virginia Tech Carilion School of Medicine
Assistant Clinical Professor of Orthopaedics, University of Virginia 
Institute for Orthopaedics and Neurosciences

Comment (1)
Jeffrey C. King
November 19, 2021 1:17 am

Bravo!!! Bravo, well written!


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