The effects of single education session on physiotherapy students' knowledge levels and thoughts on accreditation.

BACKGROUND: and Purpose: In the global landscape, quality assurance is paramount for educational institutions to adapt and thrive. The accreditation process involves evaluating an institution's quality according to standards established by experts and officially documenting its level of quality. This study aimed to assess the impact of a single educational session on physiotherapy and rehabilitation students' awareness and understanding of accreditation processes, recognizing their vital role in quality assurance. METHODS: A pretest-posttest design was employed with 211 students from a physiotherapy and rehabilitation department. Data were collected using a questionnaire assessing demographic information, knowledge about accreditation, and thoughts regarding accreditation. The educational session focused on accreditation criteria and processes, involving presentations and interactive discussions. McNemar's analysis was used to compare the response rates given by the students pre-and post-session. RESULTS: Analysis after the education session revealed a significant increase in students' knowledge of accreditation concepts (p < 0.05). Positive attitudes towards accreditation were reinforced, with students recognizing its importance in education quality. Despite pre-existing positive attitudes, the educational intervention enhanced students' understanding and engagement in accreditation processes with a significant increase in three of the eight questions on thoughts about accreditation (p < 0.05). DISCUSSION: This study underscores the efficacy of educational interventions in fostering student engagement and awareness of accreditation. Findings suggest the need for integrating accreditation education into curricula and advocating its significance through seminars and literature support, ultimately enhancing student participation in quality assurance processes.

Mapping of MPH programs in terms of geographic distribution across various universities and institutes of India-A desk research.

Background: Landscaping studies related to public health education in India do not exclusively focus on the most common Masters of Public Health (MPH) program. The field of public health faces challenges due to the absence of a professional council, resulting in fragmented documentation of these programs. This study was undertaken to map all MPH programs offered across various institutes in India in terms of their geographic distribution, accreditation status, and administration patterns. Methodology: An exhaustive internet search using various keywords was conducted to identify all MPH programs offered in India. Websites were explored for their details. A data extraction tool was developed for recording demographic and other data. Information was extracted from these websites as per the tool and collated in a matrix. Geographic coordinates obtained from Google Maps, and QGIS software facilitated map generation. Results: The search identified 116 general and 13 MPH programs with specializations offered by different universities and institutes across India. India is divided into six zones, and the distribution of MPH programs in these zones is as follows, central zone has 20 programs; the east zone has 11; the north zone has 35; the north-east zone has 07; the south zone has 26; and the west zone has 17 MPH programs. While 107 are university grants commission (UGC) approved universities and institutes, only 46 MPH programs are conducted by both UGC approved and National Assessment and Accreditation Council (NAAC) accredited universities and institutes. Five universities are categorized as central universities; 22 are deemed universities; 51 are private universities; and 29 are state universities. Nine are considered institutions of national importance by the UGC, and four institutions are recognized as institutions of eminence. All general MPH programs span 2 years and are administered under various faculties, with only 27 programs being conducted within dedicated schools or centers of public health. Conclusion: The MPH programs in India show considerable diversity in their geographic distribution, accreditation status, and administration pattern.

Development and evaluation of a societal core robotic surgery accreditation curriculum for the UK.

Standardised proficiency-based progression is the cornerstone of safe robotic skills acquisition, however, is currently lacking within surgical training curricula. Expert consensuses have defined a modular pathway to accredit surgeons. This study aimed to address the lack of a formal, pre-clinical core robotic skills, proficiency-based accreditation curriculum in the UK. Novice robotic participants underwent a four-day pre-clinical core robotic skills curriculum incorporating multimodal assessment. Modifiable-Global Evaluative Assessment of Robotic Skills (M-GEARS), VR-automated performance metrics (APMs) and Objective Clinical Human Reliability Analysis (OCHRA) error methodology assessed performance at the beginning and end of training. Messick's validity concept and a curriculum evaluation model were utilised. Feedback was collated. Proficiency-based progression, benchmarking, tool validity and reliability was assessed through comparative and correlational statistical methods. Forty-seven participants were recruited. Objective assessment of VR and dry models across M-GEARS, APMs and OCHRA demonstrated significant improvements in technical skill (p < 0.001). Concurrent validity between assessment tools demonstrated strong correlation in dry and VR tasks (r = 0.64-0.92, p < 0.001). OCHRA Inter-rater reliability was excellent (r = 0.93, p < 0.001 and 81% matched error events). A benchmark was established with M-GEARS and for the curriculum at 80%. Thirty (63.82%) participants passed. Feedback was 5/5 stars on average, with 100% recommendation. Curriculum evaluation fulfilled all five domains of Messick's validity. Core robotic surgical skills training can be objectively evaluated and benchmarked to provide accreditation in basic robotic skills. A strategy is necessary to enrol standardised curricula into national surgical training at an early stage to ensure patient safety.

Scaling training facilities for patent and proprietary medicine vendors in Nigeria: insights and lessons learned for policy implication and future partnerships.

Patent and proprietary medicine vendors in Nigeria play a very integral role in providing primary health care services and are an important source of care for the poor. They are located close to communities and are often the first source of care for hygiene and family planning (FP) products and treatment of child illnesses. Since 2017, Pharmacy Council of Nigeria (PCN) has partnered with Society for Family Health through the IntegratE project to address the poor quality of services by patent and proprietary medicine vendors (PPMVs) and reposition them for better service delivery through piloting the three-tier accreditation system. The partnership has engendered innovation for human resource for health, and considering the peculiarity of their situation, new emerging methods and arrangements to deliver the training to PPMVs in diverse geographical locations within their catchment areas are developed. In this study, we aimed to discuss the role of patent and proprietary medicine vendors in the provision of quality health delivery and provide key lessons and recommendations which have been learned from the pilot scaling of training facilities for PPMVs in Nigeria through the IntegratE project. From the lessons learnt, we propose that, for a successful scale-up of implementation of the three-tier accreditation of PPMVs, PCN will have to establish a budget line for accreditation. In addition, the government should also consider supporting this training through the Basic Healthcare Provision Fund as a way of strengthening human resources at the primary healthcare level. Other alternative sources of funding include licensing and registration fees and other dues generated internally by PCN.

Hospital Accreditation Status and Treatment Differences Among Black Patients With Colon Cancer.

Importance: Hospital-level factors, such as hospital type or volume, have been demonstrated to play a role in treatment disparities for Black patients with cancer. However, data evaluating the association of hospital accreditation status with differences in treatment among Black patients with cancer are lacking. Objective: To evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of guideline-concordant care and mortality among non-Hispanic Black patients with colon cancer. Design, Setting, and Participants: This population-based cohort study used the National Program of Cancer Registries, which is a multicenter database with data from all 50 states and the District of Columbia, and covers 97% of the cancer population in the US. The participants included non-Hispanic Black patients aged 18 years or older diagnosed with colon cancer between January 1, 2018, and December 31, 2020. Race and ethnicity were abstracted from medical records as recorded by health care facilities and practitioners. The data were analyzed from December 7, 2023, to January 17, 2024. Exposure: CoC hospital accreditation. Main Outcome and Measures: Guideline-concordant care was defined as adequate lymphadenectomy during surgery for patients with stages I to III disease or chemotherapy administration for patients with stage III disease. Multivariable logistic regression models investigated associations with receipt of guideline-concordant care and Cox proportional hazards regression models assessed associations with 3-year cancer-specific mortality. Results: Of 17 249 non-Hispanic Black patients with colon cancer (mean [SD] age, 64.8 [12.8] years; 8724 females [50.6%]), 12 756 (74.0%; mean [SD] age, 64.7 [12.8] years) were treated at a CoC-accredited hospital and 4493 (26.0%; mean [SD] age, 65.1 [12.5] years) at a non-CoC-accredited hospital. Patients treated at CoC-accredited hospitals compared with those treated at non-CoC-accredited hospitals had higher odds of receiving guideline-concordant lymphadenectomy (adjusted odds ratio [AOR], 1.89; 95% CI, 1.69-2.11) and chemotherapy (AOR, 2.31; 95% CI, 1.97-2.72). Treatment at CoC-accredited hospitals was associated with lower cancer-specific mortality for patients with stages I to III disease who received surgery (adjusted hazard ratio [AHR], 0.87; 95% CI, 0.76-0.98) and for patients with stage III disease eligible for chemotherapy (AHR, 0.75; 95% CI, 0.59-0.96). Conclusions and Relevance: In this cohort study of non-Hispanic Black patients with colon cancer, patients treated at CoC-accredited hospitals compared with those treated at non-CoC-accredited hospitals were more likely to receive guideline-concordant care and have lower mortality risk. These findings suggest that increasing access to high-quality guideline-concordant care at CoC-accredited hospitals may reduce variations in cancer treatment and outcomes for underserved populations.

An Approach to the Design and Development of an Accredited Continuing Professional Development e-Learning Module on Virtual Care.

Unlabelled: Virtual care appointments expanded rapidly during COVID-19 out of necessity and to enable access and continuity of care for many patients. While previous work has explored health care providers' experiences with telehealth usage on small-scale projects, the broad-level adoption of virtual care during the pandemic has expounded opportunities for a better understanding of how to enhance the integration of telehealth as a regular mode of health care services delivery. Training and education for health care providers on the effective use of virtual care technologies are factors that can help facilitate improved adoption and use. We describe our approach to designing and developing an accredited continuing professional development (CPD) program using e-learning technologies to foster better knowledge and comfort among health care providers with the use of virtual care technologies. First, we discuss our approach to undertaking a systematic needs assessment study using a survey questionnaire of providers, key informant interviews, and a patient focus group. Next, we describe our steps in consulting with key stakeholder groups in the health system and arranging committees to inform the design of the program and address accreditation requirements. The instructional design features and aspects of the e-learning module are then described in depth, and our plan for evaluating the program is shared as well. As a CPD modality, e-learning offers the opportunity to enhance access to timely continuing professional education for health care providers who may be geographically dispersed across rural and remote communities.

Leadership Succession Planning for ANCC Accredited Providers in Nursing Continuing Professional Development.

Succession planning in leadership is a strategic process used to identify and develop future leaders to fill key organizational positions. This process ensures continuity of leadership and helps maintain the organization's performance over time. Succession planning is essential for critical roles and can be part of a broader strategic plan for talent management. Organizations that are accredited by the American Nurses Credentialing Center (ANCC) in Nursing Continuing Professional Development (NCPD) can benefit from implementing succession planning to drive the stability of its work as an Accredited Provider and confirm that the organization maintains its commitment to quality in providing NCPD. This column describes how the Accredited Provider Program Director (AP-PD) role can benefit from implementing succession planning into the structure of the Accredited Provider processes. [J Contin Educ Nurs. 2024;55(7):321-325.].

What are the perceptions of faculty and academic leaders regarding the impact of accreditation on the continuous quality improvement process of undergraduate medical education programs at Caribbean medical schools?

BACKGROUND: Accreditation and regulation are meant for quality assurance in higher education. However, there is no guarantee that accreditation ensures quality improvement. The accreditation for Caribbean medical schools varies from island to island, and it could be mandatory or voluntary, depending on local government requirements. Caribbean medical schools recently attained accreditation status to meet the Educational Commission for Foreign Medical Graduates (ECFMG) requirements by 2024. Literature suggests that accreditation impacts ECFMG certification rates and medical schools' educational processes. However, no such study has examined accreditation's impact on continuous quality improvement (CQI) in medical schools. This study aims to gather the perceptions and experiences of faculty members and academic leaders regarding the impact of accreditation on CQI across Caribbean medical schools. METHODS: This qualitative phenomenological study inquiries about the perceptions and experiences of faculty and academic leaders regarding accreditation's impact on CQI. Purposive and snowball sampling techniques were used. Participants were interviewed using a semi-structured interview method. Fifteen participants were interviewed across ten Caribbean medical schools representing accredited medical schools, accreditation denied medical schools, and schools that never applied for accreditation. Interviews were audio recorded, and thematic data analysis was conducted. RESULTS: Thematic analysis yielded six themes, including accreditation and CQI, CQI irrespective of accreditation, faculty engagement and faculty empowerment in the CQI process, collecting and sharing data, ECFMG 2024 requirements, and organizational structure of CQI. CONCLUSIONS: There is ongoing quality improvement at Caribbean medical schools, as perceived by faculty members and academic leaders. However, most of the change process is happening because of accreditation, and the quality improvement is due to external push such as accreditation rather than internal motivation. It is recommended that Caribbean medical schools promote internal quality improvement irrespective of accreditation and embrace the culture of CQI.

Improving lung point-of-care ultrasound (POCUS) training and accreditation - a multidisciplinary, multi-centre and multi-pronged approach to development and delivery using the action learning process.

BACKGROUND: Point-of-Care Ultrasound (POCUS) consists of a range of increasingly important imaging modalities across a variety of specialties. Despite a variety of accreditation pathways available in the UK, lung POCUS training remains difficult to deliver and accreditation rates remain suboptimal. We describe a multidisciplinary, multi-centre, and multi-pronged approach to lung POCUS education within a region. METHODS: A survey was conducted in a region. From these results, bottlenecks were identified for improvement. We utilised key stages in an established accreditation pathway, and the Action Learning process. Analysing participant feedback, consensus amongst the team, regional educational needs, and leveraging the expertise within the faculty, we implemented several solutions which were multidisciplinary, multi-centre, and multi-pronged. We also set up a database across several accreditation pathways to facilitate supervision and assessment of rotational trainees. RESULTS: Utilising the Action Learning process, we implemented several improvements at elements of the lung ultrasound accreditation pathways. An initial regional survey identified key barriers to accreditation: lack of courses (52%), lack of mentors (93%), and difficulty arranging directly supervised scans (73%). A multidisciplinary team of trainers was assembled. Regular courses were organised and altered based on feedback and anecdotal educational needs within the region. Courses were set up to also facilitate continuing professional development and exchange of knowledge and ideas amongst trainers. The barrier of supervision was removed through the organisation of regular supervision sessions, facilitating up to fifty scans per half day per trainer. We collected feedback from courses and optimised them. Remote mentoring platforms were utilised to encourage asynchronous supervision. A database of trainers was collated to facilitate triggered assessments. These approaches promoted a conducive environment and a commitment to learning. Repeat survey results support this. CONCLUSION: Lung ultrasound accreditation remains a complex educational training pathway. Utilising an education framework, recruiting a multidisciplinary team, ensuring a multi-pronged approach, and fostering a commitment to learning can improve accreditation success.

Cancer Survivorship Care in the United States at Facilities Accredited by the Commission on Cancer.

Importance: Since 2021, American College of Surgeons Commission on Cancer (CoC) accreditation standards require providing a survivorship program for patients with adult-onset cancer treated with curative intent. Since more than 70% of all patients with cancer in the US are treated at CoC-accredited facilities, this presents an opportunity for a landscape analysis of survivorship care availability. Objective: To determine the prevalence, types, and outcomes of cancer survivorship services at CoC-accredited facilities. Design, Setting, and Participants: This survey study used an anonymous, online, cross-sectional survey conducted from May 4 to 25, 2023. Participants were CoC-accredited facilities in the US representing diverse CoC program categories, institutional characteristics, geographic regions, and practice types. Department of Veterans Affairs cancer programs were excluded due to data usage restrictions. Data were analyzed from July to October 2023. Exposure: CoC Survivorship Standard 4.8 was released in October 2019 and programs were expected to adhere to the Standard beginning January 1, 2021. Main Outcomes and Measures: Questions included self-reported survivorship program characteristics, availability of services aligned to CoC Survivorship Standard 4.8, and perceived program impacts. Response frequencies and proportions were determined in aggregate and by CoC program category. Results: There were 1400 eligible programs, and 384 programs participated (27.4% response rate). All regions and eligible program categories were represented, and most had analytic caseloads of 500 to 4999 patients in 2021. Most survivorship program personnel included nurses (334 programs [87.0%]) and social workers (278 programs [72.4%]), while physical (180 programs [46.9%]) and occupational (87 programs [22.7%]) therapists were less common. Services most endorsed as available for all survivors were screening for new cancers (330 programs [87.5%]), nutritional counseling (325 programs [85.3%]), and referrals to specialists (320 programs [84.7%]), while treatment summaries (242 programs [64.7%]), and survivorship care plans (173 programs [43.0%]), sexual health (217 programs [57.3%]), and fertility (214 programs [56.9%]) were less common. Survivorship services were usually delivered by cancer treatment teams (243 programs [63.3%]) rather than specialized survivorship clinics (120 programs [31.3%]). For resources needed, additional advanced practice clinicians with dedicated survivorship effort (205 programs [53.4%]) and electronic health record enhancements (185 programs [48.2%]) were most endorsed. Lack of referrals and low patient awareness were endorsed as the primary barriers. A total of 335 programs (87.2%) agreed that Survivorship Standard 4.8 helped advance their programs. Conclusions and Relevance: These findings of this survey study of CoC-accredited programs establish a benchmark for survivorship care delivery in the US, identify gaps in specific services and opportunities for intervention, contribute to longitudinal reevaluation for tracking progress nationally, and suggest the value of survivorship care standards.

Integrating the 4Ps in masters-level nursing education.

BACKGROUND: The curriculum for our generalist masters in nursing program required a heavy credit load of science courses shared with the nurse practitioner programs. The bundle of required courses far exceeded the masters in nursing program completion outcomes, increasing tuition costs and prolonging the program of study for students who were not seeking advanced practice credentials. PURPOSE: The purpose of this project was to streamline the curriculum and better align course content with MS program expected learning outcomes, student learning needs, and recent accreditation requirements. PROCESS: Course expected learning outcomes were drafted and mapped to program expected learning outcomes and AACN The Essentials: Core Competencies for Professional Nursing Education (2021) concepts and sub-competencies. A two-course series totaling 5 credits was developed to integrate the 4Ps (pathophysiology, pharmacology, physical/health assessment, and health promotion) into an online master's level nursing curriculum while decreasing the total number of credits. OUTCOMES: A total of 67 students successfully completed the online courses during the first semester. Minor revisions based on student feedback were made after the first implementation. CONCLUSIONS: Integrating the 4Ps into a series of two courses is a feasible option for streamlining a generalist masters in nursing curriculum.

Hospital accreditation in Mexico fails to improve the quality of healthcare: lessons from an impact evaluation.

Healthcare quality in low- and middle-income countries poses a significant challenge, contributing to heightened mortality rates from treatable conditions. The accreditation of health facilities was part of the former health reform in Mexico, proposed as a mechanism to enhance healthcare quality. This study assesses the performance of hospital accreditation in Mexico, utilizing indicators of effectiveness, efficiency, and safety. Employing a longitudinal approach with controlled interrupted time series analysis (C-ITSA) and fixed effects panel analysis, administrative data from general hospitals in Mexico is scrutinized. Results reveal that hospital accreditation in Mexico fails to enhance healthcare quality and, disconcertingly, indicates deteriorating performance associated with increased hospital mortality. Amidst underfunded health services, the implemented accreditation model proves inadequately designed to uplift care quality. A fundamental redesign of the public hospital accreditation model is imperative, emphasizing incentives for structural enhancement and standardized processes. Addressing the critical challenge of improving care quality is urgent for Mexico's healthcare system, necessitating swift action to achieve effective access as a benchmark for universal healthcare coverage.

Establishing surgical volume benchmarks for Orthopaedic Trauma Association (OTA)-accredited fellowship training.

INTRODUCTION: Case volumes of trauma centers and surgeons influence clinical outcomes following orthopaedic trauma surgery. This study quantifies surgical volume benchmarks for Orthopaedic Trauma Association (OTA)-accredited fellowship training in the United States. METHODS: This was a retrospective cross-sectional study of orthopaedic trauma fellows graduating between 2018 and 2019 to 2022-2023. Case volume percentiles were calculated across categories and variability defined as the fold-difference between 90th and 10th percentiles. Temporal trends were assessed with linear regression. RESULTS: 446 orthopaedic trauma fellows were included in this study. Mean reported case volume increased from 898 ± 245 in 2018-2019 to 974 ± 329 in 2022-2023 (P = 0.066). Mean case volume was 924 over the study period and mostly consisted of other (418 cases, 45 %), subtrochanteric/intertrochanteric femoral neck (84 cases, 9 %), open fracture debridement (72 cases, 8 %), pelvic ring disruption / fracture (55 cases, 6 %), acetabular fracture (41 cases, 4 %), tibial shaft fracture (39 cases, 4 %), and femoral shaft fracture (38 cases, 4 %) cases. Overall variability in total reported case volume was 2.0. Variability was greatest in distal radius fracture (14.8), amputation (9.5), fasciotomy (8.0), and proximal humerus repair (5.0). CONCLUSION: Graduates from OTA-accredited fellowship training perform 924 cases on average, which exceeds the current minimum requirement of 600 cases. Case volume benchmarks can assist trainees and faculty align training goals with fellowship program strengths. More research is needed to determine evidence-based case minimum requirements for core competency training in orthopaedic trauma surgery.

Diversity, Equity, Inclusion, and Belonging in Veterinary Education.

Interweaving diversity, equity, and inclusion (DEI) into the standards for accreditation requires veterinary schools to review their curriculum and determine what framework works best for them to implement those changes. The Competency-Based Veterinary Education framework is one that is available via the American Association of Veterinary Medical Colleges (AAVMC) to reach those standards. Five standards have DEI components versus having a single standard of DEI as previously Standards of Accreditation by the Council on Education had approved.

Is Program Director Gender Associated With Gender Diversity Among Orthopaedic Surgery Residency Programs?

BACKGROUND: Women remain underrepresented in leadership roles, faculty roles, and among residents in orthopaedic surgery. It has been suggested that having women in leadership positions in orthopaedic surgery may help to increase the gender diversity of residency programs. However, to our knowledge, no study has explored the relationship, if any, between the gender of the residency program director and the percentage of women in the residency program. QUESTIONS/PURPOSES: (1) Is the program director's gender associated with differences in the percentage of women orthopaedic surgery residents? (2) Do women and men differ in the time to appointment of program director? METHODS: A list of 207 orthopaedic surgery residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) website for the academic year 2021 to 2022. The study excluded 6% (13) of programs; 4% (8) were those without ACGME accreditation and those with initial accreditation, and 2% (5) did not have updated 2021 to 2022 resident lists. Descriptive information on 194 programs was obtained from publicly accessible resources from July 2021 through July 2022. The institution's website and the American Medical Association's (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) was used to collect residency program characteristics and resident demographics [ 2 ]. Doximity, Healthgrades, and LinkedIn were used to further collect current orthopaedic surgery residency program director demographics, including gender, age, and education/training history. To determine gender, photographs and pronouns (she/her/hers or he/him/hers) used in their biographies were used first. To confirm this, secondary sources were used including their NPI profile, which lists gender; Doximity; and their LinkedIn profile. Scopus was used to analyze research output by the program directors-using the Hirsch index (h-index) as the primary bibliometric metric. A total of 194 program directors were identified, of whom of 12% (23) were women and 88% (171) were men. Of the 4421 total residents among these programs, 20% (887) were women and 80% (3534) were men. A univariate analysis comparing program directors was conducted, with continuous variables analyzed using an independent-sample t-test and categorical variables analyzed using a Pearson chi-square test. With the numbers available, a post hoc statistical power calculation indicated that we could detect an 32% difference in the percentage of women in a program as significant with 80% power at the p < 0.05 level, whereas we might have been underpowered to discern smaller differences than that. RESULTS: With the numbers available, we found no difference in the percentage of women in residency programs run by women program directors than in programs in which the program director was a man (22% [125 of 558] versus 20% [762 of 3863], mean difference 2% [95% CI -1.24% to 7.58%]; p = 0.08). Comparing women to men program directors, women had fewer years between residency completion and appointment to the position of program director (8 ± 2 years versus 12 ± 7 years, mean difference 4 years [95% CI 2.01 to 7.93 years]; p = 0.02) and had a lower mean h-index (7 ± 4 versus 11 ± 11, mean difference 4 [95% CI 1.70 to 6.56]; p = 0.03) and number of publications (24 ± 23 versus 41 ± 62, mean difference 17 [95% CI 3.98 to 31.05]; p = 0.01), although they did not differ in terms of their advanced degrees, duration of training, or likelihood of having taken a fellowship. CONCLUSION: Orthopaedic residency programs that were run by women did not contain a higher percentage of women residents, suggesting that the gender of the individual in that role may not be as important as has been speculated by others. Future studies should investigate the intersectionality of gender, race, and ethnicity of residents, program directors, and current faculty. CLINICAL RELEVANCE: The fact that women were placed in program director roles earlier in career may also carry special jeopardy for them. Those roles are difficult and can impair a faculty member's ability to conduct individual research, which often is key to further academic promotions. Given that and the fact that the gender of the program director was not associated with differences in gender composition of residency programs, we believe that increasing mentorship and access to pipeline programs will help promote diversity in residency programs.