In the field of orthopaedics, the pursuit of excellence extends beyond clinical expertise or surgical precision. It encompasses a commitment to diversity, equity, and inclusion (DEI). As healthcare professionals, orthopaedic surgeons and allied staff have a responsibility to create environments where all patients and colleagues feel respected, supported, and valued. This responsibility extends to actively engaging in “allyship”—a proactive and supportive role in advocating for marginalized groups.

During the AAOS 2024 Annual Meeting, the Instructional Course Lecture (ICL) titled “Allyship: A ‘How-To’ Guide” was home of an immersive and lively discussion regarding DEI with a specific focus on allyship within orthopaedics.

The moderators of the ICL were Kevin F. Purcell, MD, current trauma fellow at the University of Cincinnati, and Izuchukwu Ibe, MD, assistant professor of joint arthroplasty and musculoskeletal oncology at the University of Mississippi Medical Center Department of Orthopaedics and Rehabilitation. They were joined by a diverse panel that included Michael Archdeacon, MD, FAAOS, professor and chairman of the Department of Orthopaedics at the University of Cincinnati; Lori Reed, MD, FAAOS, associate professor of foot and ankle surgery at the University of Mississippi Medical Center; John Morellato, MD, associate professor of orthopaedic trauma at University of Mississippi Medical; Marvin Dingle, MD, hand, upper-extremity, and microvascular surgeon at Walter Reed National Medical Center; Christian A. Pean, MD, orthopaedic trauma specialist at Duke Orthopaedic Trauma Clinic; and Patrick A. Massey, MD, MBA, FAAOS, vice chair of orthopaedic surgery and residency program director at LSU Health Shreveport.

The objectives of the ICL were increasing knowledge regarding the importance of the issues surrounding DEI, as well as identifying concrete methods and techniques that foster allyship within an orthopaedic department.

What is allyship?
Allyship involves individuals from privileged or dominant groups actively supporting and advocating for marginalized individuals or communities. Allyship encompasses deep curiosity, humble acknowledgment, vulnerable interactions, and authentic conversations. In the context of orthopaedics, this also means recognizing and addressing disparities in healthcare access, outcomes, and representation.

According to Dr. Reed, “[Allyship is] someone in a position of power willing to help someone that’s not in a position of power gain some insight and credibility.”

Echoing her sentiments, Dr. Archdeacon said, “Take the opportunity and, when you’re in a leadership position, do something impactful, intentional. [Allyship is] basically trying to open the doors that may not be open otherwise.” Continued allyship is not passive; it requires ongoing education, self-reflection, and action to dismantle systemic barriers and promote inclusivity.

Organizational stages of development
In many organizations, a common sight is the superficial acknowledgment of diversity without substantive changes to organizational culture, mission, or structure. This phenomenon, which Dr. Massey referred to as a “checkbox organization,” occurs when DEI initiatives are checked off without genuine commitment to inclusivity and diversity.

Although some organizations may actively recruit and promote diverse members, the real challenge lies in critically examining institutional limitations. Dr. Purcell recalled discussions he was a part of as the only Black male resident when diversity initiatives were being introduced at his institution. These discussions involved introspective meetings to assess strategies for diversification and inclusivity. Engaging in uncomfortable conversations and having open dialogues among colleagues are crucial during this process, Dr. Purcell noted.

However, he went on to say that true progress goes beyond increasing representation of different identities in an institution; it involves fostering a multicultural organization. According to Dr. Purcell, cross-cultural mentoring is meant to cultivate mutually enriching relationships across various dimensions of diversity, including race, gender, ethnicity, religion, sexual orientation, socioeconomic background, and nationality.

The three Vs
Dr. Massey explained the concept of “the three Vs,” which are vital components to successful cross-cultural mentoring: values, virtues, and vision. “Values are what we have in common. That’s where you start,” he said. “Engage in open discussions, open communication. Get outside of your comfort zone,” he advised.

On the other hand, virtues are behaviors focused on taking action for societal benefit, not personal benefit. Virtues, Dr. Massey explained, can cultivate connections and remove barriers between people. Faculty who are underrepresented in medicine need to make themselves accessible, he emphasized. “Sometimes it’s something small. Sometimes just having someone else notice that you’re having a hard time because of [or] by virtue of who you are and acknowledging that [struggle]—that goes a long way,” Dr. Dingle shared.

Lastly, vision refers to clearing pathways for more inclusive futures and overcoming limitations. Dr. Archdeacon underscored the importance of leadership in setting standards for behavior and culture within medical institutions. He emphasized that long-term commitment is required to effect meaningful change.

“If you’re in a leadership role, you have a short amount of time that you can make an impact on something,” Dr. Archdeacon said. “It may seem like a long time, but 10 or 15 years is not that long in the history of things.” He noted that although addressing individual incidents is important, it is equally crucial to work toward broader cultural shifts. Leaders must be dedicated to promoting inclusivity and actively challenging discriminatory attitudes and behaviors in the workplace.

At its core, allyship is meant to build a future for medical students and residents that is more inclusive. As Dr. Morellato explained, allyship is about “providing some opportunities for [medical students and residents] that they may not have had.”

Dr. Massey offered a few words of advice as the session came to a close. “Teach professionalism, teach skills, data analysis, statistics,” he said. “But ultimately empower students with connections in the medical field.” He encouraged attendees to take the time to identify existing resources, ally with fellow faculty and nurses, and seek help from outside organizations.

Cailin Conner is the associate editor of AAOS Now. She can be reached at cconner@aaos.org.