Braids twists and surgical knots (BTSK): piloting a culturally-centered program for early surgical exposure

Pipeline or “pathway” programs are common methods employed to increase diversity, equity, and inclusion in the surgical workforce. However, low retention and high attrition rates lead to “pathway detours” and limit substantial change (Abelson et al. in Am J Surg 215:542–548, 2018). Thus, Black individuals make up 5% of practicing surgeons and their representation continues to decrease (Iwai et al., in JAMA Surg 158:1328–1334, 2023; Bingmer et al., in Am J Surg 220:1174–1178, 2020). Given the need for creative recruitment strategies, this paper describes a novel community-based early exposure program designed to bolster current pathway initiatives.

Braids, Twists, and Surgical Knots (BTSK) is a novel initiative encouraging Black girls to consider a career in surgery by illustrating parallels to the common practices of Black hairstyling. In partnership with a local organization, seventeen girls from sixth through twelfth grade were recruited to participate in seminar sessions and workshops demonstrating the interpersonal and dexterous skills common to surgery and cosmetology. Panel discussions and select student interviews were recorded. Students and surgeons were asked to complete corresponding surveys for program evaluation. Data were analyzed using a mixed methods approach.

At baseline, a majority of responding students agree that hair is important to their cultural identity (85%). Most students (92%) and surgeons (88%) also report a background skill in hairstyling. The event was the first time all students met a Black woman surgeon. Surgeons described unique difficulties of navigating Black hair in a surgical career, while students reported improved self-perception of their hair and associated skills as a result of the program. Overall, feedback received from students, surgeons, and hairstylists centered around representation, self-empowerment, and the power of interdisciplinary connections with one surgeon describing the program as a “revolution” in its concept.

BTSK supplements current pipeline programming by meeting communities where they are, leveraging Black hair as an integral component of cultural identity. This innovative approach can be extrapolated for other underrepresented minority (URM) groups, using relevant cultural foci to connect with communities in future program iterations.