An Equity, Diversity, and Inclusion glossary for sociodemographic determinants of health within critical care medicine.

PURPOSE: Equity, Diversity, and Inclusion (EDI) initiatives within critical care research are limited by a lack of resources and inconsistent and rapidly changing language. The Canadian Critical Care Trials Group (CCCTG) is committed to modelling EDI for the critical care community through its programming, communications, protocols, and policies. The objective of developing the EDI glossary of sociodemographic determinants of health described here was to provide a resource for critical care professionals to support broader equity initiatives and to promote education and awareness about inclusive language. METHODS: Through literature review, we identified EDI-related sociodemographic determinants of health, defined as sociodemographic factors that are associated with disparities in health care and health outcomes, with a focus on critical care medicine. For each sociodemographic determinant of health, we identified umbrella terms (defined as domains) and subterms/constructs that are related to these domains. We designed the glossary collaboratively with the CCCTG EDI working group, patient and family partnerships committee, and executive committee, which included diverse knowledge users such as researchers, clinicians, and patient and family partners. RESULTS: We report on 12 sociodemographic determinants of health domains including age, sex, gender, sexuality, race and ethnicity, income, education, employment status, marital status, language, disability, and migration status. Each domain (e.g., sex) contains relevant subterms such as male, female, intersex. For each domain, we provide examples of disparities in health care and health outcomes with a focus on critical care medicine. CONCLUSIONS: This EDI glossary of sociodemographic determinants of health serves as a nonexhaustive resource that may be referenced by critical care researchers, research coordinators, clinicians, and patient and family partners. The glossary is an essential step to raising awareness about inclusive terminology and to fostering and advancing equity in critical care medicine.

RéSUMé: OBJECTIF: Les initiatives en matière d'équité, de diversité et d'inclusion (EDI) dans le cadre de la recherche en soins intensifs sont limitées à la fois par un manque de ressources et par un langage incohérent et évoluant rapidement. Le Groupe canadien de recherche en soins intensifs (CCCTG) s'est engagé à devenir un modèle en matière d'EDI pour la communauté des soins intensifs par le biais de ses programmes, de ses communications, de ses protocoles et de ses politiques. L'objectif de l'élaboration du glossaire pour les déterminants sociodémographiques de la santé respectant l'EDI décrit ici était de fournir une ressource aux professionnel·les des soins intensifs pour soutenir des initiatives d'équité plus larges et de promouvoir l'éducation et la sensibilisation au langage inclusif. MéTHODE: En procédant à l'examen de la littérature, nous avons identifié des déterminants sociodémographiques de la santé liés à l'EDI, définis comme des facteurs sociodémographiques associés à des disparités dans les soins de santé et les devenirs en santé, en mettant l'accent sur la médecine des soins intensifs. Pour chaque déterminant sociodémographique de la santé, nous avons identifié des termes génériques (définis comme des domaines) et des sous-termes/construits liés à ces domaines. Nous avons conçu le glossaire en collaboration avec le groupe de travail sur l'EDI du CCCTG, le comité des partenariats avec les patient·es et les familles et le comité exécutif, qui comprenait divers utilisateurs et utilisatrices des connaissances tels que des personnes impliquées dans la recherche ou en clinique ainsi que des partenaires issu·es de la patientèle et de leurs familles. RéSULTATS: Nous rendons compte de 12 domaines sociodémographiques pour les déterminants de la santé, notamment l'âge, le sexe, le genre, la sexualité, la race et l'origine ethnique, le revenu, l'éducation, la situation d'emploi, l'état matrimonial, la langue, le handicap et le statut migratoire. Chaque domaine (par exemple, le sexe) contient des sous-termes pertinents tels que masculin, féminin, intersexe. Pour chaque domaine, nous fournissons des exemples de disparités dans les soins de santé et les issues en matière de santé, en mettant l'accent sur la médecine des soins intensifs. CONCLUSION: Ce glossaire EDI des déterminants sociodémographiques de la santé sert de ressource non exhaustive qui peut être consultée par les équipes de recherche en soins intensifs, les coordonnateurs et coordonnatrices de recherche, les clinicien·nes et les patient·es ainsi que les familles. Ce glossaire est une étape essentielle pour sensibiliser à la terminologie inclusive et pour favoriser et faire progresser l'équité en médecine des soins intensifs.

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In this narrative medicine essay, a pediatric infectious disease physician relates how he has learned to understand the protective role of code-shifting in his life and how that understanding has aided him in promoting an inclusive environment in academic medicine.

Evaluating equity, diversity, and inclusion in Canadian Postgraduate Medical Education: A cross-sectional analysis of online content.

BACKGROUND: Medical graduates applying to Residency through the Canadian Resident Matching System (CaRMS) utilize the internet to gather information on programs and their overarching Postgraduate Medical Education (PGME) Office. This study aims to evaluate how PGME websites across Canada convey their commitment to equity, diversity, and inclusion (EDI) through their website features. METHODS: Cross-sectional analysis of the 17 Canadian PGME websites against 20 EDI criteria based on contemporary literature, across five domains: leadership and governance, recruitment, accommodations, community engagement, and pathways to entry. Non-parametric testing was conducted to explore the relationship between EDI performance and municipal population diversity and geographic region. RESULTS: The evaluation of PGME websites, policies, reports, and plans revealed a mean score of 8.65/20 (SD = 3.00), with scores ranging from a minimum of 4/20 to a maximum of 13/20, indicating variability in EDI representation. Specifically, the domain of leadership and governance demonstrated the highest mean proportion of completed criteria (51%), while community engagement had the lowest (24%). Notably, 9 out of 17 PGME websites (53%) met at least 10 EDI criteria. Analysis by geographic region demonstrates significant mean differences (p = 0.02), with Ontario (10.50, SD = 2.17) and Western Provinces (11.00, SD = 0.00) scoring notably higher than Quebec (4.50, SD = 0.58), the Prairies (8.50, SD = 2.12), and the Atlantic region (8.00, SD = 2.83). CONCLUSIONS: The assessment of Canadian PGME websites reveals varying levels of commitment to EDI. While many programs exhibit strong EDI representation in mission statements, access to mental health services, and anti-discrimination policies, there are notable gaps in leadership messaging, diverse interview panels, family-friendly policies, and deliberate recruitment of underrepresented groups. Regional differences highlight the need for sharing best practices to promote inclusivity across the country. Improving EDI efforts on PGME websites can promote the recruitment and retention of a diverse resident population.

Exploring the Impact of Equity, Diversity, and Inclusion Initiatives Within a Canadian Nursing Program: A Pilot Study.

Interventions that aim to address equity, diversity, and inclusion (EDI) within the health professions often strive to promote the retention, recruitment, and success of individuals from historically underrepresented groups, who often belong to the same groups experiencing underservicing in health care. A pilot study aimed to examine the impact of ongoing EDI initiatives at Dalhousie University in Nova Scotia, Canada by exploring sense of belonging and curricular inclusion/representation from the perspectives of enrolled students. Intersectionality Theory was operationalized by way of considering the relational and contextual nature of marginalization. Results showed differences in perceptions of impacted sense of belonging and curricular inclusion/representation of diverse groups between respondents in the underrepresented subgroup as compared to their overrepresented counterparts. Differences in underrepresented and overrepresented subgroups' perceptions of impacted sense of belonging and curricular inclusion/representation suggest a need for further research to better understand the impact of EDI interventions on nursing students.

Increasing Diversity, Equity, Inclusion, and Accessibility in Rare Disease Clinical Trials.

Diversity, equity, inclusion, and accessibility (DEIA) are foundational principles for clinical trials and medical research. In rare diseases clinical research, where numbers of participants are already challenged by rarity itself, maximizing inclusion is of particular importance to clinical trial success, as well as ensuring the generalizability and relevance of the trial results to the people affected by these diseases. In this article, we review the medical and gray literature and cite case examples to provide insights into how DEIA can be proactively integrated into rare diseases clinical research. Here, we particularly focus on genetic diversity. While the rare diseases DEIA literature is nascent, it is accelerating as many patient advocacy groups, professional societies, training and educational organizations, researcher groups, and funders are setting intentional strategies to attain DEIA goals moving forward, and to establish metrics to ensure continued improvement. Successful examples in underserved and underrepresented populations are available that can serve as case studies upon which rare diseases clinical research programs can be built. Rare diseases have historically been innovation drivers in basic, translational, and clinical research, and ultimately, all populations benefit from data diversity in rare diseases populations that deliver novel insights and approaches to how clinical research can be performed.

A PROGRESS-driven approach to cognitive outcomes after traumatic brain injury: A study protocol for advancing equity, diversity, and inclusion through knowledge synthesis and mobilization.

Evidence syntheses for advancing equitable traumatic brain injury (TBI) research, policy, and practice presents formidable challenges. Research and clinical frameworks are currently not specific to equity, diversity, and inclusion considerations, despite evidence that persons with TBI live in societies in which power imbalances and systems of social dominance may privilege some people and marginalize others. The present protocol outlines a strategy for a research program, supported by the Canadian Institutes of Health Research, that explores the integration of PROGRESS-Plus parameters in research with the goal of advancing open-science databases and tools to improve our understanding of equity in cognitive and brain health outcomes in TBI. PROGRESS-Plus is a framework outlining social, economic, and cultural parameters that may influence health opportunities and outcomes (e.g., place of residence, race, occupation, gender, etc.). A multistep research program is proposed to support three objectives: (1) organizing existing data on TBI-induced changes in cognition and brain health into a template to facilitate future research, including research using machine learning techniques; (2) updating published evidence with a more rigorous approach to the consideration of PROGRESS-Plus parameters; and (3) mobilizing knowledge on the current state of evidence that is relevant, equitable, and accessible. This program facilitates partnerships with knowledge users across clinical, research, academic, and community sectors to address the three research objectives through a unifying workflow of exchange, synthesis, and knowledge mobilization. We anticipate that this global collaboration between topic experts and community leaders in equity in brain health will add significant value to the field of TBI by promoting equity-transformative advancements in knowledge synthesis, policy, and practice.

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.

The misperception of organizational racial progress toward diversity, equity, and inclusion.

Despite a checkered racial history, people in the United States generally believe the nation has made steady, incremental progress toward achieving racial equality. In this article, we investigate whether this U.S. racial progress narrative will extend to how the workforce views the effectiveness of organizational efforts surrounding diversity, equity, and inclusion. Across three studies (N = 1,776), we test whether Black and White U.S. workers overestimate organizational racial progress in executive representation. We also examine whether these misperceptions, surrounding organizational progress, drive misunderstandings regarding the relative ineffectiveness of common organizational diversity policies. Overall, we find evidence that U.S. workers largely overestimate organizational racial progress, believe that organizational progress will naturally improve over time, and that these misperceptions of organizational racial progress may drive beliefs in the effectiveness of diversity, equity, and inclusion policies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Promoting equity, diversity, and inclusion in surveys: insights from a patient-engaged study to assess long COVID health-care needs in Brazil.

BACKGROUND AND OBJECTIVE: Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may persist for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socioeconomically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC health care and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS: Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in 3 guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of health-care access. RESULTS: The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our 3 principles through survey content, instrument design, and administration. Six hundred fifty-one participants with diverse LC symptoms, demography, and socioeconomic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION: By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.

Ten recommendations for hosting a Diversity, Equity, Inclusion, and Justice (DEIJ) journal club.

Despite advances and social progress, the exclusion of diverse groups in academia, especially science, technology, engineering, and mathematics (STEM) fields, across the US and Europe persists, resulting in the underrepresentation of diverse people in higher education. There is extensive literature about theory, observation, and evidence-based practices that can help create a more equitable, inclusive, and diverse learning environment. In this article, we propose the implementation of a Diversity, Equity, Inclusion, and Justice (DEIJ) journal club as a strategic initiative to foster education and promote action towards making academia a more equitable institution. By creating a space for people to engage with DEIJ theories* and strategize ways to improve their learning environment, we hope to normalize the practice and importance of analyzing academia through an equity lens. Guided by restorative justice principles, we offer 10 recommendations for fostering community cohesion through education and mutual understanding. This approach underscores the importance of appropriate action and self-education in the journey toward a more diverse, equitable, inclusive, and just academic environment. *Authors' note: We understand that "DEIJ" is a multidisciplinary organizational framework that relies on numerous fields of study, including history, sociology, philosophy, and more. We use this term to refer to these different fields of study for brevity purposes.

Diversity, Equity, and Inclusion in Urolithiasis Clinical Trials: Representative Enrollment by Race, Ethnicity, and Sex.

INTRODUCTION: We sought to assess whether participant enrollment is appropriately representative of the overall urolithiasis population in published urolithiasis clinical trials. METHODS: PubMed was queried for urolithiasis US clinical trials published from 2000 to 2022. Trials were evaluated for reporting patient race/ethnicity and sex data. These were then compared to the stone prevalence reported by the National Health and Nutrition Examination Survey from 2015 to 2018. We calculated a representation quotient (RQ) to describe enrollment of patients and then stratified by geographic location, study type, and funding source. RESULTS: Of the 180 urolithiasis trials performed in the US, we identified 40 trials (22%) reporting race or ethnicity and 104 trials (58%) reporting sex. Male and female participants are well represented (RQ 0.97 and 1.02, respectively). Overall, the RQ of Black, Asian American and Pacific Islander, White, Hispanic, and mixed/other participants is 1.84, 1.06, 1.04, 0.46, and 0.34, respectively. Trials completed in the Western Section and multi-institutional trials have the most proportional enrollment, while trials in the South Central and Southeastern Sections have underrepresentation of mixed/other and Hispanic patients. Enrollment was similar among all trial subtypes. Government- and industry-funded trials had more diverse enrollment than academic-funded trials. CONCLUSIONS: Only 1 in 4 published US urolithiasis trials report race or ethnicity enrollment. Mixed race and Hispanic participants are consistently underrepresented, while Black participants are overrepresented. Government- and industry-sponsored multi-institutional trials have the most proportional representation. Investigators should prioritize inclusive recruitment and improve reporting practices to accurately reflect the diversity of the urolithiasis population.