Evaluating equity, diversity, and inclusion in Canadian Postgraduate Medical Education: A cross-sectional analysis of online content
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SUBMITTER: Bondok M
PROVIDER: S-EPMC11349208 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Background Physician-patient racial and cultural concordance is essential to address health care disparities. Yet, limited literature on diversity, equity, and inclusion (DEI) outcomes in graduate medical education (GME) suggests the need for high-yield DEI resources. Objectives To describe and identify DEI efforts by US residency program director (PD) associations and areas for collaboration among the GME community. Methods Through bimonthly teleconferences and 5 iterative revisions from June to September 2022, the DEI workgroup of the US Organization of PD Associations developed a 17-question needs assessment survey to investigate DEI activities across residency PD associations, which was delivered twice electronically from September to November 2022 to 30 specialty PD association representatives. Results Survey response rate was 73% (22 of 30). Specialties track resident demographics more than PD demographics (11 of 22, 50% vs 7 of 22, 32%). Tracked demographics vary and include race, gender, and sexual orientation. Most PD associations have DEI committees (16 of 22, 73%) implementing various initiatives, the most common of which was providing resources to ensure diverse representation (11 of 16, 69%). Most specialties provide residency recruitment resources (14 of 22, 64%) and funding for visiting rotations or mentorship for underrepresented trainees (12 of 22, 54%). Resources for pipeline programs (7 of 22, 32%) and retention of diverse residents (7 of 22, 32%) were less common. Faculty development training focused more on teaching DEI to residents (14 of 22, 64%) than on teaching health disparities (7 of 22, 32%). Conclusions Our study demonstrates substantial DEI interventions among specialty PD associations. Yet, educational gaps exist in specific DEI content, faculty development, and curricular dissemination.
| S-EPMC11475428 | biostudies-literature
Project description:ObjectivesTo increase diversity and inclusion in graduate medical education (GME), the Accreditation Council for Graduate Medical Education (ACGME) issued new diversity standards requiring programs to engage in practices that focus on systematic recruitment and retention of a diverse workforce of trainees and faculty. The literature on how program directors (PDs) can incorporate and prepare for this standard is limited.MethodsWe developed a diversity, equity, and inclusion (DEI) toolkit for PDs as an example of an institutional GME-led effort to promote inclusive recruitment and DEI awareness among residency and fellowship programs at a large academic center.ResultsA survey was sent to 80 PDs before the launch of the toolkit and 6 months afterwards with response rates of 27% (22/80) and 97% (78/80), respectively. At baseline, 45% (10/22) anticipated that the DEI toolkit might provide better resources than those currently available to them and 41% (9/22) perceived that the toolkit might improve recruitment outcomes. At 6 months, 63% (49/78) found the toolkit helpful in the 2021-2022 recruitment season. By contrast, 2% (2/78) of PDs did not find the toolkit helpful, and 33% (26/78) said they did not access the toolkit. When asked if a PD changed their program's recruitment practices because of the toolkit, 31% (24/78) responded yes. Programs that changed recruitment practices started to require unconscious bias training for all faculty and residents involved in the residency interviews and ranking. Others worked on creating a standardized scoring rubric for interviews focused on four main domains: Experiences, Attributes, Competencies, and Academic Metrics.ConclusionThere is a need to support PDs in their DEI journey and their work to recruit a diverse workforce in medicine. Utilizing a DEI toolkit is one option to increase DEI knowledge, skills, awareness, and self-efficacy among PDs and can be adopted by other institutions and leaders in academic medicine.
| S-EPMC10563453 | biostudies-literature
Project description: Not available
| S-EPMC7901635 | biostudies-literature
Project description:BackgroundAs the Accreditation Council for Graduate Medical Education (ACGME) began to ask programs to report their efforts surrounding diversity, equity, and inclusion (DEI), program directors felt ill prepared to evaluate their programs and measure change.ObjectiveTo develop a tool that would allow graduate medical education (GME) programs to evaluate the current state of DEI within their residencies, identify areas of need, and track progress; to evaluate feasibility of using this assessment method within family medicine training programs; and to analyze and report pilot data from implementation of these milestones within family medicine residency programs.MethodsThe Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed a tool for program DEI evaluation modeled after the ACGME Milestones. These milestones focus on DEI assessment in 5 key domains: Institution, Curriculum, Evaluation, Resident Personnel, and Faculty Personnel. After finalizing a draft, a pilot implementation of the milestones was conducted by a convenience sample of 10 AFMRD DHE Task Force members for their own programs.ResultsScores varied widely across surveyed programs for all milestones. Highest average scores were seen for the Curriculum milestone (2.65) and the lowest for the Faculty Personnel milestone (2.0). Milestone assessments were completed within 10 to 40 minutes using various methods.ConclusionsThe AFMRD DEI Milestones were developed for program assessment, goal setting, and tracking of progress related to DEI within residency programs. The pilot implementation showed these milestones were easily used by family medicine faculty members in diverse settings.
| S-EPMC9017255 | biostudies-literature
Project description:BackgroundAcademic medicine needs more diverse leadership from racial/ethnic minorities, women, people with disabilities, and LGBTQIA+ physicians. Longitudinal structural support programs that bring together underrepresented in medicine (UiM) and non-UiM trainees are one approach to build leadership and scholarship capacity in diversity, equity, and inclusion (DEI).ObjectiveTo describe the creation, satisfaction with, and feasibility of a Leadership Education in Advancing Diversity (LEAD) Program and evaluate scholars' changes in self-efficacy, intended and actual behavior change, and outputs in leadership and DEI scholarship.MethodsIn 2017, we created the LEAD Program, a 10-month longitudinal, single institution program that provides residents and fellows ("scholars") across graduate medical education (GME) with leadership training and mentorship in creating DEI-focused scholarship. In the first 3 cohorts (2017-2020), we assessed scholars' self-efficacy, actual and planned behavior change, and program satisfaction using IRB-approved, de-identified retrospective pre-/post-surveys. We measured scholarship as the number of workshops presented and publications developed by the LEAD scholars. We used descriptive statistics and paired 2-tailed t tests to analyze the data.ResultsSeventy-five trainees completed LEAD; 99% (74 of 75) completed the retrospective pre-/post-surveys. There was statistically significant improvement in scholars' self-efficacy for all learning objectives. All trainees thought LEAD should continue. LEAD scholars have created workshops and presented at local, regional, and national conferences, as well published their findings. Scholars identified the greatest benefits as mentorship, developing friendships with UiM and ally peers outside of their subspecialty, and confidence in public speaking.ConclusionsLEAD is an innovative, feasible GME-wide model to improve resident and fellow self-efficacy and behaviors in DEI scholarship and leadership.
| S-EPMC8672828 | biostudies-literature
Project description:ImportanceClosing the diversity gap is critical to ensure equity in medical education and health care quality. Nevertheless, evidence-based strategies and best practices to improve diversity, equity, and inclusion (DEI) in the biomedical workforce remain poorly understood and underused. To improve the culture of DEI in graduate medical education (GME), in 2020 the Accreditation Council of Graduate Medical Education (ACGME) launched the Barbara Ross-Lee, DO, Diversity, Equity, and Inclusion Award to recognize exceptional DEI efforts in US residency programs.ObjectiveTo identify strategies and best practices that exemplary US GME programs use to improve DEI.Design and settingThis qualitative study performed an exploratory content analysis of award applications submitted to the ACGME over 2 cycles in 2020 and 2021, using the constant comparative method. The research team first acknowledged their own biases related to DEI, used caution to not overinterpret the data, and performed several cross-checks during data analysis to ensure confirmability of the results. A preliminary codebook was developed and used during regular adjudication sessions. Disagreements were discussed until agreements were reached.Main outcomes and measuresFoundational (ie, commonly cited, high-impact, and small-effort strategies considered achievable by all programs) and aspirational (ie, potential for high impact but requiring greater effort and investment) DEI strategies used by exemplary GME programs.ResultsThis qualitative study included 29 award applications submitted between August 17, 2020, and January 11, 2022. Strategies spanned the education continuum from premedical students through faculty. Foundational strategies included working with schools, community colleges, and 4-year college campuses; providing structured support for visiting students; mission-driven holistic review for admissions and selection; interviewer trainings on implicit bias mitigation and on how racism and discrimination impact admission processes and advancement; interview-day DEI strategies; inclusive selection and DEI committees; mission statements that include DEI; and retention efforts to improve faculty diversity. Aspirational strategies included development of longitudinal bidirectional collaborations (eg, articulation agreements, annual workshops, funded rotations and/or research) with organizations working with applicants who were historically excluded and underrepresented in medicine, blinding metrics in residency applications, longitudinal curricula on DEI and health equity, and faculty mentoring such as affinity groups, mentored research, and joint academic-community recruitments. Findings provide residency program leadership with a menu of options at various inflection points to foster DEI within their programs.Conclusions and relevanceThe findings of this qualitative study suggest that GME programs might adopt strategies of exemplary programs to improve DEI in residency, ensure compliance with accreditation standards, and improve health outcomes for all.
| S-EPMC9909494 | biostudies-literature
Project description:IntroductionWomen and ethnic minorities are underrepresented at all levels of training and practice in urology residency programs. Equity, diversity, and inclusion (EDI) is a growing field of interest in medical research and business literature, especially regarding recruitment. The objective of this review was to evaluate evidence-based strategies to increase EDI to improve urology residency recruitment.MethodsA review was conducted using Ovid Medline to identify publications reporting strategies to increase women and underrepresented minorities (URM ) in healthcare fields. An evaluation of business models was incorporated. Identified strategies were sorted and ranked based on how many papers reported an increased proportion of women or URM in their program following implementation.ResultsWe assessed 234 publications from 1972-2022. Eleven underwent full review. Six additional pieces of business literature were reviewed and incorporated. The following methods were most often identified to increase diversity: mentorship and holistic application review (six publications), as well as funded internship programs and diverse selection committees (four publications). Diversity statements and application blinding were highlighted by multiple business sources but were each only reviewed in one medical publication.ConclusionsRecommendations identified include mentorship, holistic application review by diverse selection committees with bias training, and development of funded internship programs. Standardized questions and rubrics were also well-studied. Business strategies, such as publishing diversity statements and application blinding, are less studied in medical education literature. This study is unique in its inclusion of both medical and business literature and highlights concrete strategies for urology residency programs to increase EDI during recruitment.
| S-EPMC10426422 | biostudies-literature
Project description:BackgroundPerson-centred care (PCC) involves placing people at the centre of their healthcare decision making to ensure it meets their needs, values, and personal circumstances. Increasingly, PCC is promoted in healthcare policy and guidance, but little is known about how this is embedded in postgraduate medical training. The aim of this research was to understand how PCC is embedded in UK postgraduate medical training and explore factors influencing inclusion of PCC in curricula content.MethodsTo explore this, we interviewed senior professionals with key roles in the curricula from four UK Royal Colleges (Psychiatrists; Physicians; Surgeons; and GPs) and used framework analysis on interviews and relevant curricula documents to identify themes.ResultsLegislation and professional/educational guidance influenced inclusion. PCC definitions and terminology differed and placement within curricula was variable. Royal Colleges defined the curriculum and provided training to ensure competence, but local deaneries independently implemented the curriculum. Trainer engagement was greater than trainee buy in. Quality assurance focused on feedback from trainers and trainees rather than patients, and patient and public involvement in curriculum development, teaching, and assessment was limited.ConclusionsThere is a need for cross-organisation collaboration to develop a PCC competence framework that defines the skills and level of competence required at different points in training, with clarity around the differences between undergraduate and postgraduate requirements. Greater auditing and quality assurance of programme delivery would help identify successful practices to share within and across Royal Colleges, while still maintaining the flexibility of local provision. Engagement with patients and the public in this work can only strengthen provision.
| S-EPMC10568751 | biostudies-literature
Project description:Efforts toward achieving diversity, equity, inclusion, and justice (DEIJ) within graduate medical education (GME) often begin with the formation of a DEIJ committee that steers the work. Little is known about the experiences and the challenges faced by those serving on such committees. We sought to describe the experiences of members of our institutional GME DEIJ committee to gain knowledge that would propel this work forward. An open-ended survey was electronically administered to members of our institutional GME DEIJ committee. Responses were analyzed using a rapid qualitative analytical approach. Eighteen members (58%) responded. Of these, (67%) were women and five (28%) were Black. Six domains emerged: "motivation," "challenges," "emotional response," "highs," "facilitators," and "advice." Black respondents more often cited the need to increase diversity as a motivator to join this work. Women and Black respondents more often identified time constraints as a challenge to participation. Some members found the work emotionally draining; others described it as uplifting. Two themes emerged as high points of participation-pride and achievement around the work completed and the personal benefits of building a community with a shared purpose. Three themes emerged as facilitators: effective leadership, support, and establishing psychological safety during the meetings. Many arrived at the realization that change would take time and advocated for patience and perseverance. Protected time and DEIJ expertise were identified as integral to successful committee work. Our findings provide novel insights into the experience of serving on a GME DEIJ committee and highlights infrastructural and institutional prerequisites for success.
| S-EPMC9091374 | biostudies-literature
Project description:ObjectiveA mixed methods survey was conducted at a health sciences library to assess patrons' perceptions of the library's digital and physical environments in relation to diversity, equity, and inclusion (DEI).MethodsDeveloped by the library's DEI Team and preceded by a pilot assessment, the survey posed 17 Likert Scale questions and 2 free-text response questions on the topics of belonging, inclusivity, equitability, emotional and physical safety, and commitment to DEI. The survey was created in Qualtrics, pilot tested, and launched in February 2020 for approximately 12 weeks.ResultsObjective question responses were received from 101 individuals, with 24 open-ended responses. The quantitative findings showed largely positive perceptions of the DEI climate. Questions about feeling welcome and feeling physically safe were among those with the highest responses. The three lower-scoring questions indicate areas for improvement, including services for people whose native language is not English, for individuals with disabilities, and for families. The qualitative findings indicate the library's strengths include its exhibitions, welcoming atmosphere, and LGBTQ+ inclusivity initiatives. In contrast, opportunities for enhancement encompass non-English language resources, website updates, and accessibility to some physical spaces.ConclusionThe DEI Team is using the online survey data to enhance library services, staffing, programming, policies, and spaces. These improvements include looking into providing a space for patrons with families, expanding services for individuals whose first language is not English, assessing library accessibility for people with physical disabilities, and enhancing the physical space with quiet areas, improved lighting, and meditation spaces. Employee DEI training is ongoing, using results from a training needs survey to identify knowledge gaps. The library has a history of successful partnerships with campus entities, which will help the DEI Team to move forward with their work.
| S-EPMC10124613 | biostudies-literature