About

Stephen Rodrigue Estime, MD, is an Associate Professor of Anesthesia and Critical Care at the University of Chicago. He completed his anesthesiology residency at the University of Chicago in 2015 and a critical care fellowship at Brigham and Women's Hospital in Boston, MA, in 2016. His clinical practice includes roles as an Anesthesiologist in the operating room and a Critical Care Physician in the Trauma-Surgical Intensive Care Unit. His academic interests and work focus on quality improvement and patient safety, particularly related to emergency airway management in critically ill patients. He is also dedicated to health equity, with a focus on reducing healthcare disparities. Dr. Estime serves as the Director of Diversity & Inclusion in the Graduate Medical Education office and leads Diversity, Equity, and Inclusion initiatives within the Department of Anesthesia.

Research topics

• Medicine
• Anesthesia
• Internal medicine
• Emergency medicine
• Social Science
• Surgery
• Computer Science
• Environmental health
• Law
• Medical emergency
• Demography
• Intensive care medicine
• Risk analysis (engineering)

Selected publications

• Understanding Implicit Bias and Responding to Microaggressions

  2024-08-29

  book-chapter1st authorCorresponding

  Abstract Implicit biases are unconscious associations about groups of people that can manifest as actions expressing prejudice, which can unwittingly perpetuate discrimination and are known as microaggressions. An understanding of implicit bias and microaggressions is an important skills for functioning as an effective leader in healthcare. Given the role of physicians as leaders who navigate difficult social and clinical interactions, these principles are especially pertinent. An understanding of one’s personal biases allows for improved communication in high-stakes interactions, may lead to better health outcomes and patient–provider interactions, and is a core component of professionalism. Addressing implicit bias at the individual level demands the acknowledgment that everyone harbors biases, that feedback is an important mechanism to uncover bias, and that adjusting one’s actions will allow for better future interactions in an increasingly complex world. At the institutional level, systems that address implicit bias can be achieved by a commitment from leadership to address bias at all levels to empower workers who may otherwise not be engaged and to offer pertinent and timely training to improve institutional diversity.

  PublisherDOI

• Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study

  Intensive Care Medicine · 2024-08-20 · 57 citations

  articleOpen access
  PublisherOA PDFDOI

• Closing the gap: Perioperative health care disparities and patient safety interventions

  International Anesthesiology Clinics · 2024-02-22 · 2 citations

  articleSenior authorCorresponding

  Rangrass, Govind MD; Obiyo, Leziga MD; Bradley, Anthony S. MD; Brooks, Amber MD; Estime, Stephen R. MD Author Information

  PublisherDOI

• Post-cardiac arrest care in the intensive care unit

  International Anesthesiology Clinics · 2023-08-25

  articleSenior author

  Cotter, Elizabeth K.H. MD; Jacobs, Matthew MD; Jain, Nisha MD; Chow, Jarva MD; Estimé, Stephen R. MD Author Information

  PublisherDOI

• Delirium in trauma ICUs: a review of incidence, risk factors, outcomes, and management

  Current Opinion in Anaesthesiology · 2023-01-03 · 9 citations

  review

  PURPOSE OF REVIEW: This article reviews the impact and importance of delirium on patients admitted to the ICU after trauma, including the latest work on prevention and treatment of this condition. As the population ages, the incidence of geriatric trauma will continue to increase with a concomitant rise in the patient and healthcare costs of delirium in this population. RECENT FINDINGS: Recent studies have further defined the risk factors for delirium in the trauma ICU patient population, as well as better demonstrated the poor outcomes associated with the diagnosis of delirium in these patients. Recent trials and meta-analysis offer some new evidence for the use of dexmedetomidine and quetiapine as preferred agents for prevention and treatment of delirium and add music interventions as a promising part of nonpharmacologic bundles. SUMMARY: Trauma patients requiring admission to the ICU are at significant risk of developing delirium, an acute neuropsychiatric disorder associated with increased healthcare costs and worse outcomes including increased mortality. Ideal methods for prevention and treatment of delirium are not well established, especially in this population, but recent research helps to clarify optimal prevention and treatment strategies.

  PublisherDOI

• Healthcare disparities in trauma: why they exist and what we can do.

  PubMed · 2022-04-01 · 7 citations

  articleSenior author

  PURPOSE OF REVIEW: This review will explore the underlying causes of healthcare disparities among trauma patients and offer considerations for reducing inequities to improve trauma care. RECENT FINDINGS: Newly recognized racial disparities exist with respect to triaging trauma patients and in acute pain management. Social Determinants of Health offers a model to understand disparity in trauma care. SUMMARY: Race, ethnicity, socioeconomic status, and access to healthcare drive outcome disparity among trauma patients. These disparities include reduced healthcare services, inadequate pain management, reduced postdischarge care, and increased mortality. Increasing workforce diversity may mitigate implicit bias and improve cultural competency. Social determinants of health impact the disparities in trauma care and offer a framework to address care through creative solutions.

  PublisherDOI

• Challenges and outcomes in airway management outside the operating room

  Current Opinion in Anaesthesiology · 2022 · 17 citations

  • Computer Science
  • Medicine
  • Intensive care medicine

  PURPOSE OF REVIEW: Airway management outside the operating room poses unique challenges that every clinician should recognize. These include anatomic, physiologic, and logistic challenges, each of which can contribute to complications and lead to poor outcomes. Recognizing these challenges and highlighting known outcome data may better prepare the team, making this otherwise daunting procedure safer and potentially improving patient outcomes. RECENT FINDINGS: Newer intubating techniques and devices have made navigating anatomic airway challenges easier. However, physiological challenges during emergency airway management remain a cause of poor patient outcomes. Hemodynamic collapse has been identified as the most common peri-intubation adverse event and a leading cause of morbidity and mortality associated with the procedure. SUMMARY: Emergency airway management outside the operating room remains a high-risk procedure, associated with poor outcomes. Pre-intubation hemodynamic optimization may mitigate some of the risks, and future research should focus on identification of best strategies for hemodynamic optimization prior to and during this procedure.

  PublisherDOI

• Using Graduate Medical Education Institutional Data to Enhance Diverse Recruitment Strategies

  Journal of Graduate Medical Education · 2022-06-01

  articleOpen access1st authorCorresponding

  Individuals identifying as Black, Latinx, Native American, Alaskan, Hawaiian, and Pacific Islander represent 33% of the US population but just 11% of the US physician workforce.1,2 Incongruity exists between the medical workforce and the US population despite studies that show underrepresented in medicine (UIM) physicians more frequently work in underserved communities, reduce health care disparities, and enhance race-concordant care, patient satisfaction, and medical treatment adherence.3-8 Accreditation bodies, including the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education, have issued workforce diversity requirements.9,10 In addition, institutional diversity metrics are now collected and reported by US News & World Report to address workforce disparity.9-11Recruiting a diverse workforce is challenging given the limited candidate pool and biased selection processes that contribute to disparities. The limited number of diverse candidates can lead to competition between institutions in attracting candidates in a zero-sum proposition that fails to address physician workforce disparity. While we do not advocate for a specific quota of diverse physicians at any one institution, a critical mass is needed to impact the long-term goal of expanding the entire pool of diverse applicants. This starts with increasing underrepresented students entering STEM (science, technology, engineering, and mathematics) pathways that lead to careers in medicine. Holistic application reviews de-emphasizing test scores and biased metrics, implicit bias training for selection committees, and review of recruitment data have been advocated to improve selection of diverse candidates in the applicant pool.12,13This perspective provides a structured approach to inclusive recruitment through recruitment data organization, strategic program recommendations, and graduate medical education (GME)-led supporting initiatives. We recognize there are many recruitment strategies that can drive diversity. Our process offers a structured recruitment framework with initiatives that can be implemented in many institutions.When the Electronic Residency Application Service (ERAS) system became fully electronic in 2017, it provided easier access to program recruitment data for centralized review and analysis. The University of Chicago's GME team collected ERAS application data and National Resident Matching Program (NRMP) Match Results by Ranked Applicants reports over 3 years (2018-2020) for our core residency programs. For simplicity, we show a single year of de-identified data (Figure). Program-specific ERAS data were aggregated so that applicants who applied to multiple programs were accounted for among each program. ERAS and NRMP data were linked through the Association of American Medical Colleges' identification numbers to track where applicants ultimately matched.We analyzed program recruitment data for self-identified UIM and non-UIM applicants. We compared the percentage that applied, were ranked, and ultimately matched for each program. Two scatterplots were created. One scatterplot compared the percentage of UIM who applied with the percentage of UIM who were ranked. The second compared the percentage of UIM who were ranked with the percentage of UIM who matched. Our institution's average for each of these values was used to separate the 2 plots into 4 quadrants (Figure). Averages were based on institutional data and were not aspirational. The aggregated data and figures provided visual representation of relative program performance so that program-specific recommendations and strategies could be discussed (Table). The GME team also provided individual program-level numerical and graphical recruitment trends over 3 years (2018-2020). The de-identified chart, best practices, and strategies within each quadrant were shared with all program directors during GME monthly meetings.The recommended strategies were proposed based on published evidence, expert opinion, and practical approaches to recruitment (Table). Programs with above-average rates of UIM at each stage of the recruitment process (applied, ranked, and matched) were encouraged to review data and share their strategies during GME meetings (Figure, Quadrants D, H). Programs with below-average UIM applications were encouraged to use similar strategies to increase applicants. Strategies considered by our programs included program branding, virtual recruitment, and collaboration with national student organizations (eg, Student National Medical Association, Latino Medical Student Association).14-17 We also recommended aligning program mission with clinical standards and focusing on mission visibility through clear messaging, marketing, and media presence emphasizing diversity and inclusion (Figure, Quadrants A, B). Programs with below average rates of UIM ranked, but average/above-average UIM who applied, were asked to review their departmental mission to ensure workforce diversity was prioritized. Revision of the selection process should ensure a holistic review of applicants and avoid implicit bias (Figure, Quadrant C). Programs with below-average UIM ranked were recommended to reassess the program mission and selection process (Figure, Quadrants E and F). Programs with average/above-average numbers of UIM ranked but below-average UIM matched, were recommended to focus on the peri-interview experience by exploring second-look visits with subsidized travel so that prospective residents gain deeper program familiarity (Figure, Quadrant G).15An important consideration is the disparity among programs that are less positioned to recruit prospective residents. Through GME-led interventions, institutional resources can better support programs that may not otherwise have dedicated staff, time, and capacity for recruitment. Two faculty diversity officers were given leadership roles in GME, each with protected 10% full-time equivalents, to enhance recruitment efforts. To increase residency applications across GME, we organized institution-wide virtual residency recruitment events, expanded our social media presence, and created video recruitment content to increase our institution's visibility. We believe these interventions appeal to younger prospective applicants who are more engaged in virtual content and platforms. A privately funded scholarship program was started to support visiting clerkship rotations for UIM medical students, and a house staff diversity committee exists for residents and fellows from across our institution to enhance inclusion and a sense of belonging. Medical students at our institution participate in these GME-supported committees in addition to other public service and social events to better engage and retain our diverse medical student body. To improve the institution's link between service and mission, the GME team launched an institution-wide community outreach program and selected 30 residents through an application process. The selected residents engaged in required, year-long community outreach initiatives and a virtual health equity curriculum. Participants received a small university-funded stipend to compensate for their time and effort in this program.Our perspective offers specific examples of GME-supported recruitment that can be implemented at many institutions. Over a 3-year recruitment cycle, we observed higher numbers of UIM applicants and higher match rates. From 2019 to 2021, total applications rose by 9.8% with the greatest increase among UIM candidates. This follows the national NRMP trend of increased applications with a 6% increase noted in the 2021 main Match.18 In 2021, our institution observed an increase in the percentage of matched UIM applicants from 14% to 24%. UIM main Match rate increases were observed among medicine-, surgical-, and hospital-based programs and among both above- and below-average programs with UIM representation. These are observational trends, and we cannot determine whether data organization, program-specific recommendations, or GME-supported initiatives caused these improvements.We believe a concentrated, centralized approach to recruitment can enhance workforce diversity beyond what may be achievable by individual programs. When a critical mass of UIM talent is achieved, mentorship, sponsorship, and premedical career pathways are enhanced. We believe this approach will drive UIM workforce representation and foster UIM physicians in all specialties to improve patient care.The authors acknowledge and thank the University of Chicago program directors, program coordinators, residents, and GME team.

  PublisherOA PDFDOI

• Extracorporeal membrane oxygenation utilization in burn patients with severe acute respiratory distress syndrome

  Burns · 2022-11-10 · 8 citations

  letterOpen accessSenior author
  PublisherOA PDFDOI

• Disparities Among Trauma Patients and Interventions to Address Equitable Health Outcomes

  Current Trauma Reports · 2022-04-06 · 1 citations

  article1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Bhakti K. Patel

  University of Chicago

  5 shared

• Dinesh J. Kurian

  University of Chicago

  5 shared

• Allison Dalton

  5 shared

• John P. Kress

  University of Chicago

  5 shared

• Michael O’Connor

  University of Chicago

  5 shared

• Deirdre Goode

  University of Illinois Chicago

  4 shared

• Thomas Spiegel

  University of Chicago

  4 shared

• David G. Beiser

  4 shared

Education

• M.D.

  University of Chicago

  2015

• Other, Critical Care Medicine

  Brigham & Women's Hospital

  2016