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Weighed down? A tangible way to support diversity, equity & inclusion

October 31, 2021

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The first-ever mastermind for women in male-dominated fields created a cocoon of safe space to discuss real challenges we share across specialties. In male-dominated fields, we can often find ourselves to be the only woman in the room. When we are lucky enough to encounter another person like us, we may have only five minutes together, as we exchange hellos in the bathroom or conference hall. There’s usually not enough time to connect on a personal level or speak about the sometimes sticky situations we can face in fields traditionally lacking in diversity, whether in gender or otherwise. During our four-day retreat, we had ample opportunity to share experiences across a range of practice locations and experience levels. It was our own mastermind addressing topics including diversity, equity, and inclusion in the traditionally male-dominated fields.

Diversity, equity and inclusion: a moral imperative

Sometimes the lack of diversity, equity, and inclusion (DEI) can affect our morale. It can directly affect the people we see around us: the person who opted out because they didn’t see anyone who was black, brown, LGBTQ, shorter than average, or any other version of “other,” like them. But DEI can be tangible, too. 

A resident at the retreat brought up an interesting example. She shared how there was no radiation protection lead apron that fit her properly at her institution. The “resident lead” was a relic from years past. It was far too heavy for her, and it was ill-fitting. They simply did not have an appropriate lead apron for a person with a small frame. She put on the ill-fitting garment and experienced back pain that very day. There was no way she would consider becoming an interventional radiologist. It was clear she did not have the constitution to stand in lead all day. At least, that was her first impression.  

Show, don’t tell: when you care about diversity equity and inclusion

Nonetheless, this resident was interested in image-guided procedures, and wanted to learn as much as she could during her rotation. So she tried to advocate for herself and those like her, requesting the program provide a small lead-equivalent garment. This could be shared by people rotating through the department. But her program declined (to put it politely), saying there was other lead for her to use. But that lead was a suboptimal one-piece design, not the two-piece design recommended for better radiation protection and decreased back strain. 

Not having the right protective equipment available is short-sighted. It’s well documented that lead aprons should be well-fitted to prevent musculoskeletal injury. Surely people rotating through the department would be of varying stature, not just the size of an average man. Especially these days, when women outnumber men in medical school classes (for the past couple of decades). Surely having a small lead apron available would benefit the department for years to come. But the program admin didn’t invest in a smaller lead apron. What a shame.  

How to Stand Up for Yourself, and for Diversity Equity and Inclusion

This resident and I had a conversation about the physical demands of the field of interventional radiology, and fields like it. I emphasized the importance of lead that fits. Furthermore, contemporary “lead” aprons are much lighter, using materials like barium, tungsten, tin, and antimony. This makes lead equivalent aprons 20–40% lighter than standard lead aprons

After speaking with me, she decided to buy her own lead apron, a significant investment on a resident’s salary. When she put on the apron fitted to her small frame, she was shocked. There was no back pain this time, and she was now prepared “to work a 12-14 hour day, no problem.” She could now enjoy her IR rotation and experience what it was like to do the work, without the distraction of ill-fitting or excessively heavy lead. This has allowed her love of IR to blossom, and now her career trajectory is straight into IR. It’s astounding to think that this person, a trainee of the highest caliber, nearly disqualified herself from her intended career based on a lack of appropriate equipment in the department. And the responsibility of having this equipment should not be on the trainee. The responsibility belongs to her hospital and program administrators. 

A ubiquitous challenge and clear target for improvement

I think back to my own experience rotating through various parts of radiology. There was a somewhat random assortment of lead available. Not infrequently, an XL was the only size available. I’m sure someone thought it could ostensibly protect “everyone,” be they large or small in stature. You wouldn’t want a large person in a lead apron that was too small, or their radiation protection would be inadequate. So, as an average-sized female, I’d don an XL lead, and wrap the straps around my body, tying the velcro straps in a bow in front, since these large aprons were too oversized to use the appropriate velcro closure on the hips.

We make do with what we have. For short procedures like a barium swallow, poorly fitting lead might be okay. In a couple of minutes, you’d be out of the lead and back at your desk interpreting studies. But in surgically-oriented fields like IR and surgery, in which we can stand and work in these garments for hours, their size actually matters. 

People wonder why we don’t see more women flocking into fields like these. This example illustrates why. If we want to increase the number of women entering fields like interventional radiology, interventional cardiology, vascular surgery, or orthopaedic surgery (among others), we need to welcome them. Making appropriate protective equipment available is one way to do that.

Improving DEI: It’s not such a mystery sometimes

Let’s do less talking and theorizing about how to improve the pipeline of diversity in the demographically skewed fields of medicine and surgery. Instead, let’s take a look at the tangible, everyday ways in which we can support the next generation of physician colleagues. If we listen, they’ll tell us what they need. And that’s what happened last week at our mastermind retreat. Ideas and solutions were flowing. 

So what can you do? If you’re a resident or medical student and you notice this problem in your department, point it out to someone who can do something about it. At my institution, a department manager employed by the hospital orchestrates the measuring and ordering of protective equipment for everyone. At a training program, you may need to contact your Program Director. Find out who’s in charge of ordering lead and help them understand the need you identify.

If you’re a fellow or attending, you should have your own lead fitted to your specific measurements. Assuming you do, take a look at your supply of “guest,” “resident,” or “student” lead. Does it only accommodate a certain body type or stature?

While protective garments are adjustable to a degree, there should be more than one size available. If the only size available is large, you have a problem. If you don’t have more than one size lead represented, or if the guest lead is over a decade old, speak to your administration about it. You can order contemporary, lighter lead aprons to help prevent long term musculoskeletal problems.

To accommodate an increasingly diverse workforce, encourage your decision-makers to order a few different sizes of protective lead aprons, at a minimum. Having lead that fits different bodies is the kind of inclusion you can FEEL. The future of your field depends on it. 

It’s up to you, too

What tangible opportunities for improvement do you see in your department, hospital, or workplace?

What tangible steps have you taken to support diversity in your practice? Share in the comments section below!

To see an example of what a fitted, 2-piece lead apron looks like, and how you put it on, check out this video:

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