Introduction

The Canadian Association of Emergency Physicians (CAEP) is the national voice of emergency medicine (EM) in Canada and has the opportunity and obligation to promote equity, diversity, and inclusion (EDI) for its members and the patient population they serve.

EDI is a phrase used to describe policies and programs that promote the representation and participation of different groups of individuals including people of different ages, races and ethnicities, differing abilities, genders, religions, cultures, and sexual orientations [1].

This is the second of four papers in the series “Leadership for Change”. The first paper provided an overview of existing EDI strategies and programs as well as a framework for addressing bias and discrimination through collaborative leadership, equitable policies and procedures, and training and education for allyship. In this second paper, we present a summary of CAEP’s work in this area thus far, following this framework. The third paper will explore participatory facilitation as a collaborative leadership strategy for centering EDI and the final paper will provide a framework for individuals to lead change through local EDI initiatives. While we encourage readers to access the three accompanying papers in this series, each paper also stands alone.

EM is the interface between community and hospital care and is the only access route to care for many. It serves as the safety net for all. Patients presenting to the emergency department (ED) deserve care that is competent, caring, and inclusive. Meeting this need necessarily includes centering EDI.

Addressing bias and discrimination

CAEP has been a strong voice for the consideration of social context in EM, including increasing recognition of EM in rural and remote settings. The impacts of bias in healthcare in Canada have long been recognized by patients, trainees, and healthcare providers [2,3,4]. Recent events including the COVID-19 pandemic have heightened attention to inequities and racism in healthcare practices, systems, and organizations for the general population. The deaths of Brian Sinclair [5] and Joyce Echaquan [6] underscore the urgency of action in emergency medicine. The CAEP Board of Directors (BOD) has identified a need to better align the initiatives of the association with the values of diversity, inclusion, and active anti-racism. Recognizing that EDI must be a strategic focus, the Canadian Association of Emergency Physicians (CAEP) set a new direction to establish and operationalize EDI-focused systems, practices, and programs. While public commitment to EDI principles is essential, as in CAEP’s position statements on gender equity [7] and racism [8], EDI statements alone are not enough. CAEP has put EDI principles into practice through training and education, policy and procedural support, and by engaging leadership in short- and long-term EDI-centered strategic planning. Further details on this strategic planning process and resulting goals are presented in paper 3 of this series.

Training and education for allyship

Centering EDI in the national CAEP conference. The CAEP conference is CAEP’s flagship event and is the largest gathering of emergency physicians in Canada with over 1000 attendees per year. In 2021, the CAEP conference’s first objective was to “Integrate the values of equity, diversity and inclusivity in the organization of EM, in the delivery of patient care and in daily practice”. The conference included its first ever symposium on EDI in EM. The symposium was attended by more than 70 emergency physicians and resulted in recommendations at the individual physician, department, and hospital level for addressing racism and colonialism [2], improving gender equity [9], and advancing education about gender and sexual minorities [10] in EM in Canada. This symposium was informed by the input of patient and community advisors as well as a virtual national public forum on equity in EM. The conference also featured sessions on advocacy and the impact of the social determinants of health on the well-being of emergency department patients.

The 2022 CAEP conference was built on this momentum to “Integrate concepts of social cohesion and a recognition of the social, cultural, and linguistic plurality of practicing emergency medicine in Canada”. The conference continued to live up to CAEP’s commitment by including a symposium featuring EDI considerations in the resident selection process, sessions on opportunities for advocacy by emergency physicians, and, for the first time, the conference hosted a presentation track dedicated to social EM.

Rather than targeted speaker invitations, for the 2023 conference, we created an open call for speaker submissions, similar to the established research abstract submission process. The conference also includes a track dedicated to Society and EM, ensuring that at least 20% of the conference talks, workshops, and panels will offer perspective on the impact of context on the practice of EM. Readers are encouraged to visit https://caepconference.ca for more information.

National grand rounds. In response to the COVID-19 pandemic, in mid-2020, CAEP established a biweekly virtual national grand rounds program. Recognizing the opportunity within this format to provide practice-changing EDI-focused education, in November 2020, CAEP hosted a 1 h session titled, “Toward Equity, Diversity and Inclusion: Starting the Conversation”. This was the first national presentation on EDI for emergency medicine physicians in Canada. It was followed by three subsequent EDI-focused rounds in 2021 and four in 2022. The January 2021 equity-focused rounds on sickle cell disease were the first to feature a patient speaker. Select rounds were made available for free to non-CAEP members given the importance of these topics. Eighty to 118 participants registered for each session from across the country with more than 300 subsequent views of the session recordings. Most attendees indicated that they planned to use information learned in the sessions in their practice (range 76–100%). Readers are encouraged to visit https://caep.ca/cpd-courses/caep-national-grand-rounds for information on upcoming sessions.

Collaborative leadership

CAEP identified a need for education and strategy development for its own BOD to promote allyship, sponsorship and true inclusion across the association. The details of this strategic planning session, the application of participatory facilitation as a strategy for organizational change, and the resulting short and long-term action items are further described in the third paper of this series.

Equitable policies and procedures

EDI Advisory Group. CAEP recognized that long-term meaningful change required the establishment of structural support within its organization. The BOD created its first group of EDI advisors by recruiting emergency physicians with related expertise. This group worked with the CAEP BOD to develop a virtual EDI information center providing resources for CAEP members on education programs, existing guidelines, key articles, books, social media sites, and related advocacy organizations. This page will be a permanent feature of CAEP’s online presence: https://caep.ca/who-we-are/equity-diversity-and-inclusion-information-centre/.

Awards adjudication process. The advisory group worked with the CAEP BOD to revise the national awards process, creating the Equity in Awards Adjudication Guidelines (Fig. 1). These emphasize the importance of making equity an explicit goal in the awards process, the necessity of related training for selection committee members, and the need for representation on the selection committee of members of underrepresented groups in medicine. The awards selection committee is now blinded to nominee names and pronouns to further limit gender and racial biases. Of the CAEP award recipients for 2021 and 2022, 45% were female-presenting and 30% were members of racialized groups compared to an average 20% and 22%, respectively, in earlier years. While we recognize that diversity is represented by more than racial and gender identity, this trend represents an important shift in the recognition of important work being done in EM by members of traditionally underrepresented groups.

Fig. 1
figure 1

Infographic by Dr. Huma Ali

CAEP equity in award adjudication guidelines.

Full size image

Establishment of national committees. CAEP’s committees are opportunities for focused initiatives, networking, and mentorship. CAEP’s Women in EM (WEM) committee is well established and has been active in develo** position statements and guidelines to empower women in EM, co-hosting an international speaker series on gender equity, and creating a formal mentoring program [7, 9]. The 2SLGBTQIA + Committee (since renamed the Gender and Sexual Minority Committee) was established in 2020 and has created a mentorship program, the Visibility Project, aimed at inspiring those from the 2SLGBTQIA + community to consider a career in EM and published recommendations for education about sexual and gender minorities in Canadian emergency residency programs [10]. The Antiracism and Anticolonialism Committee was established in 2021 following the CAEP conference EDI Symposium with a commitment to address racism and colonialism in EM in the areas of patient care, physician advancement, professional development, and medical education. This is the first CAEP committee to include patients and community members on its executive.

Conclusion

We cannot provide the care our patients deserve, the teaching our learners demand, or the opportunities for advancement our colleagues need without centering EDI in EM. As the national body of emergency physicians, CAEP has a duty to its members and to the patients we serve to advance EDI in EM. Through educational interventions, changes to organizational structure, and incorporating EDI in strategic planning, CAEP is working to address barriers to care, gaps in learning, and limits to professional advancement.