Portal de Periódicos da CAPES

Let That Be Your Battlefield: Society of Asian Academic Surgeons Presidential Address

2019; Elsevier BV; Volume: 241; Linguagem: Inglês

10.1016/j.jss.2019.05.027

1095-8673

Nipun B. Merchant,

Health and Medical Research Impacts

Cue: Original Star Trek opening sound track—"Let That Be Your Last Battlefield". Stardate 5730.2, the Federation starship Enterprise is on a mission when it encounters Lokai, a political refugee from the planet Cheron. Shortly thereafter, Bele transports to the Enterprise. Bele explains that he is on a mission to retrieve political traitors. The two men despise one another because of their differences. The source of their hatred is that Bele is black on the right side and white on the left side, whereas Lokai is black on the left side and white on the right side. Bele charges that Lokai led a revolt of people who are black on the left side against the ruling order (people that are black on the right side). Lokai counters that his people were oppressed and enslaved by Bele's ruling (black/right) class of Cheron. Mr. Spock tries to explain to Bele his story of the planet Vulcan, telling him that the Vulcans were also people like him—wildly emotional, often committed to irrational opposing point of views, leading, of course, to death and destruction. Only the discipline of logic saved his planet, he explains "Change is the essential process of all existence". Once the Enterprise arrives at Cheron, Lokai and Bele realize they are each the only ones of their kind left as all on the planet have killed each other because of their hatred and bigotry. Enraged, they come to blows again and eventually beam down to their decimated planet. The Enterprise crew remarks sadly that despite the annihilation of their entire planet's population, the two are still unwilling to give up their hate. This episode aired in 1969, at the height of the civil rights movement. It starkly highlights the issue of unjust racial bigotry, making it socially relevant then and now. Bias exists in everyone, whether it is reflected in political divides, forthright bigotry, or unconscious perceptions. Our biases actually serve an evolutionary purpose. Our senses supply us with incredible amounts of data constantly. It's impossible for the human brain to process all this information. So to make our lives easier, our brains are programmed to take short cuts when interpreting data. We develop many rules that we tap into unconsciously that allow us to make instant decisions and judgments. In encouraging diversity, we say we need to get rid of bias. However, we all have personal blind spots—unconscious perceptions that influence our behavior and impact absolute results. This is readily seen in how the media has traditionally portrayed Asians. There is the stereotype of the "Asian nerd"—a tech geek, good at math and science, but socially awkward and passive. Then there is the stereotype of the Geisha girl or China doll, portrayed as exotic and beautiful, but also submissive, obedient, and fragile. Furthermore, Asian Americans are often treated as "perpetual foreigners" and unassimilable, always being asked, "Where are you really from?" On the other hand, Asians are also considered the "model minority". We are the fastest-growing racial group in the United States—the Asian population in the United States has grown 72% since 2000. Asians also have the highest level of education and highest level of income compared with whites and other minority groups in the United States (Fig. 1).1Pew Research CenterAnalysis of the 2010 American community survey.in: The Rise of Asian Americans. 2013http://www.pewsocialtrends.org/asianamericans/Date accessed: April 4, 2013Google Scholar However, Asian Americans are often combating this "model minority" stereotype. The concept that all Asian Americans are economically successful, and that other races should emulate them is a myth. It treats Asian Americans as a homogeneous entity by aggregating statistics of several different groups. In fact, Asians in the United States have a wide range of income levels (Fig. 2).2Lopez G. Ruiz N.G. Patten E. Key facts about Asian Americans, a diverse and growing populationSource: Pew research center analysis of the 2013-2015 American community survey.https://pewrsr.ch/2lheXinDate: 2017Date accessed: August 9, 2017Google Scholar The racism that Asian Americans face in society and their achievements in overcoming racism are often understated or ignored altogether and it promotes divisiveness among Asian Americans and other racial minorities. It is dehumanizing to base a people's identity on little besides, often inaccurate, perceptions of universally high income levels and education and can create even greater expectations of achievement, which can be psychologically harmful. In society, there is talk of overcoming discrimination through a social justice paradigm that espouses that people should be treated fairly and equitably. However, diversity and inclusion issues are not just about discrimination, but also about a lack of cultural awareness. It is clear that people are innately able to be more successful in a cultural model that is suited to their way of thinking or being. Take for example the company Intel. Many years ago, to help Asians (who were readily being hired) assimilate, they created Asian affinity groups. However, the company also had created a culture of "constructive conflict" that encouraged heated debates during meetings. In this environment, Chinese engineers were unhappy and not succeeding. Many would say that this is an example of unconscious bias. However I think it is more a lack of cultural awareness. It exemplifies the assumptions that Asians are good at math, science, and technology, making it easier for them to get in the door, but by putting them in an unnatural or uncomfortable environment that they are not suited to, could result in preventing their opportunities for career advancement and perpetuate an Asian stereotype of avoiding conflict. In a study of the Equal Employment Opportunity Committee tech workforce from 2007 to 2015 performed by our colleagues at ASCEND (https://www.ascendleadership.org)—the largest organization whose mission is to educate, advocate, and enable Pan-Asian business leaders—data for Asians, Hispanics, and blacks in the San Francisco Bay Area finds scant progress in upward management mobility for minority men and women.3Gee B. Peck D. The illusion of Asian success: scant progress for minorities in cracking the glass ceiling from 2007-2015.https://c.ymcdn.com/sites/www.ascendleadership.org/resource/resmgr/research/TheIllusionofAsianSuccess.pdfDate accessed: March 10, 2017Google Scholar Some key findings show that Asians were the most likely to be hired, but least likely to be promoted to managerial or executive positions, in spite of being the largest minority group of professionals. White women have made significant and important progress and are now substantially more successful in reaching the executive level than all minority men or women, emphasizing that race is now a more significant factor than gender as an impediment to climbing the management ladder. Overcoming these negative stereotypes and "Breaking the Bamboo Ceiling" remains an ongoing struggle for Asians. Asians are less likely to been seen as having leadership potential, charisma, or creativity because it is assumed that they are quiet and complacent, thereby less likely to seek out raises and promotions (lacking in confidence, not "go-getters" or risk-takers). They are often pigeonholed into certain roles based on stereotypes of being good at math or the "Asian nerd" portrayed in media. Even American-born Asians are seen, for no fact-based reason, as having weaker English and communication or interpersonal skills. Those who try to break these stereotypes are often viewed negatively by the general American population and other Asians for supposedly trying to deny their "Asian-ness" and are labeled as "coconuts" or "bananas" (derogatory terms meaning "brown" or "yellow" on the outside and "white" on the inside). When I was growing up, the Indian representation I saw on TV was Apu, the Kwik-E-Mart owner on the Simpsons—portrayed praying to a god with an elephant head and speaking with a thick accent. And, to add insult to injury, voiced by a white guy doing an impression. Even in film, a key scene from one of the Indiana Jones movies is of the Indian maharaja eating monkey brains. I can't tell you how many times I was asked if my family ate monkey brains after that movie aired! We don't, in case any of you are still wondering…. Imagine if the only white character on TV was Charlie Brown. Everyone would assume things about white men based on a fictional character. Society would think that white men are all inept, unathletic, and readily taken advantage of by women. But change is occurring, particularly in the media. Numerous shows and movies now portray Asians in leading roles that break the previous stereotypes. The Mindy Project was a successful American romantic comedy television series with Mindy Kaling, an Indian American woman, as the lead character. It follows the life of Ob/Gyn Mindy Lahiri as she tries to balance her personal and professional life. The show has been applauded for not making Kaling's race central to her character, and for showing that an Indian woman could date non-Indian men, have a successful career, and choose to have a child out of wedlock. Asian actors are now beginning to achieve recognition in American television and film. Riz Ahmed was the first Indian Muslim to win an Emmy Award and Sandra Oh is the first Asian actor to win multiple Golden Globes. And of course, there is the hugely successful movie, Crazy Rich Asians, which features an all Asian cast and lead director. Also breaking stereotypes, it features Rachel, a Chinese-American, raised by an immigrant single mom with American values. Breaking these stereotype barriers is important for Asians, many of whom have waited decades to see themselves represented onscreen in all their diversity. The founding of the Society of Asian Academic Surgeons (SAAS) can be traced to the Presidential Session on Unconscious Bias in Academic Surgery that took place during the sixth Annual Academic Surgical Congress, directed by then (first Asian) Society of University Surgeons President Dr Dai Chung. Dr Don Nakayama presented an eye-opening talk on the lack of Asians in the leadership of American academic surgery, and would later publish that data in the Annals of Surgery.4Nakayama D. Asian Americans in leadership positions in academic surgery.Ann Surg. 2012; 255: 583-588Crossref PubMed Scopus (11) Google Scholar He highlighted in his analysis that although not a minority in academic surgery, Asian American academic surgeons are absent from the governing boards of surgical organizations and editorial boards of peer-reviewed surgical journals, a situation that mentorship and the development of effective social networks though an Asian American surgeons' association may correct. It was shortly after that meeting, a group of nine Asian academic surgeons gathered to talk about the implications of that talk. This group of nine would become the founding members of SAAS. It is gratifying to note that, since that time, there have been 13 new Asians Chairs of Surgery that have been named, four of them being women! Furthermore, in 2011, there were five Asians in 166 possible leadership roles in the major surgical societies in the United States and none on the American College of Surgeons Board of Regents. Today, there are 19 Asians in 181 possible leadership roles, however, still none on the Board of Regents. Black and Hispanic representation during this time still has not changed significantly. On the bright side, however, there are now 40 women in leadership roles, including seven on the Board of Regents. That shows notable and significant progress for women in our field, but there still remains a significant lack of progress and awareness for Asians and other minorities toward assuming leadership roles in academic surgery. In this context, the leadership of SAAS has made an intentional decision to invite surgical leaders—chairs and deans—to our meetings. The purpose of this is two-fold. First, it raises the awareness of the lack of Asians in leadership roles in academic surgery. When these leaders learn of this discrepancy, the most common response we hear from them is, "I was not even aware this was a problem…". Second, having the leaders in academic surgery at our meetings provides a forum for interaction for our trainees and younger faculty with established leaders that they otherwise may not have. Our mission is to cultivate, nurture, and support the advancement of Asians in academic surgery. I believe that to be even more effective in achieving this mission, we must also continue to create other intentional partnerships. Currently, we have 233 active SAAS members. To be recognized as a Society by the American College of Surgeons, we need to have 300 active Fellow of the American College of Surgeons (FACS) members. This recognition will allow us to have representation on Board of Governors and other committees, which will help carry our voice and raise awareness on a larger platform. Therefore, I am making a plea to recruit every FACS surgeon you know to become an SAAS member so we can educate academic surgeons about our mission and achieve this recognition. Many of the leaders of our society have donated $10,000 or more, becoming part of our Lotus Circle, fully committed toward further advancing our mission. These funds have created enormous opportunities for our younger faculty through our SAAS Visiting Professorship Program, graciously hosted this year by Brigham and Women's Hospital (host: Gerard Doherty, MD), City of Hope (host: Yuman Fong, MD), Dartmouth–Hitchcock Medical Center (host: Sandra Wong, MD), University of Chicago (host: Jeffrey Matthews, MD), University of Colorado (host: Richard Schulick, MD), and University of South Florida (host: Paul Kuo, MD). These opportunities help our younger faculty to create individual partnerships and collaborations at other institutions that they may otherwise not have had, setting a foundation for their careers, while celebrating the talent of our members. I believe SAAS is now at a critical point in our history when we have to enhance our institutional and societal partnerships. We have already created a very symbiotic and fruitful partnership with ASCEND. It is now time to forge intentional relationships with the Society of Black Academic Surgeons, Association of Women Surgeons and the Asian Pacific American Medical Student Association, who have similar missions to ours for their respective members. Working together with these societies will enable us all to continue to raise awareness of the unconscious bias that exists for all minorities and women in surgical leadership and allow all of us to expand our opportunities to further our missions through collaboration and responsibility to achieve a mutual goal. It is imperative that we challenge the status quo of our time, as it will not only benefit our organizations, but society as a whole and go a long way in decreasing the polarization that exists in society today. It is also important for us to recognize that 21% of all medical students today are Asian. This creates a large pipeline of the next generation of physicians that we have to educate, mentor, and provide opportunities for. A survey by Asian Pacific American Medical Student Association looking at the challenges for Asian medical students entering academic medicine identified a lack of appropriate Asian role models/mentors as one of the major deterrents. One student wrote, "We see a deficiency of Asians in leadership positions in academia, and any efforts to make changes does not include people like me." I have had the great fortune of having truly inspiring mentors throughout my career, whose mentorship, guidance, and support have allowed me to advance in my career. However, they are also all primarily white males, and I too have not had true mentors who "look like me". SAAS was founded to focus on the personal and professional development of Asian academic surgeons with the belief that the best way to increase Asian representation in the leadership of academic surgery is to prepare future generations to succeed. To that end, our meetings have been geared to providing our members a platform for leadership development by increasing exposure of our younger members to successful Asian academic role models and also by providing opportunities for mentorship and career development to enhance communication skills, thereby creating a pipeline of Asians for leadership in academic surgery. It is gratifying to note that almost all of the current Asian surgical chairs and other Asian leaders in academic surgery are committed to the mission of SAAS, regularly attend our meetings and are integrally involved to assure its success. Charles Drew, an African American surgeon who was the first African American surgeon selected to serve as an examiner on the American Board of Surgery, said, "Excellence of performance will transcend artificial [discrimination] barriers created by man". It is toward this goal that SAAS is committed, both personally and financially, to continue to provide educational opportunities for scholarship and research. SAAS initiatives and endowments have provided numerous opportunities for our members including the Academic Surgical Congress Research Award for the highest scoring abstract from an SAAS member; the Junior Faculty Award to attend Surgical Investigator's Course; the Resident/Fellow Development Scholarship which provides a travel grant to the AAS Fall Courses; the SAAS Annual Meeting Travel Award for the highest scoring abstract at our meeting and the Society of University Surgeons Midcareer Course Travel Award for a faculty member to attend the course. All of you are familiar with the midnight ride of Paul Revere, made legendary by Henry Wadsworth Longfellow's poem. I would be very surprised, however, if anyone here knew of William Dawes. Both men rode on horseback from Boston on the night of April 18, 1775, to sound the alarm that the British were coming. Dawes rode south whereas Revere rode north. The towns they traveled through were demographically similar and both men came from the same social class and had similar educational backgrounds. However, Paul Revere was an information broker; he played a key role in a social network by connecting disparate groups of people, targeting other well-connected people during his ride and his news spread widely and quickly. His name has persisted through history. William Dawes was not an information broker. He did not know which doors to knock on when he entered a new town, so the information he carried was circulated only within a small group of people instead of expanding outward and he is forgotten in history. I highlight this example to emphasize the value of your peer-network. Look around you. These are your peers. It is important to develop relationships and create networks with the people in this room. As important as mentors are, peers can and will also have a profound effect in your careers. These are some my peers, many of whom are in the audience today, whom I have "grown up" with and who have helped me tremendously in my career, both personally and professionally and I am immensely grateful for their friendship, guidance, and support. As you can see many are "like-me" (Asian) and have understood much of the message we are talking about today. In this context, SAAS and our meetings continue to provide our members opportunities to expand your network among academic surgeons and Asian role models.