Shifting the Paradigm in Workforce Diversity: Prioritizing an Inclusive Environment in Graduate Medical Education.

ABSTRACT: A diverse physician workforce is important to achieving the goal of health equity. Recruitment efforts are often the focus of graduate medical education (GME) workforce diversity efforts. However, to achieve the goal of workforce diversity, a foundation of inclusivity is essential to address the experiences of trainees whose race and ethnicity are underrepresented in medicine (UIM).Professional identity formation (PIF) describes the process through which trainees integrate their personal and professional identities as they learn to not only act but feel like they belong in their professional role. The concept of PIF provides a framework to consider how GME leaders can intentionally address inclusivity in training programs. The process of PIF is influenced by many factors including trainees' clinical and non-clinical experiences, their treatment by others, as well as the training program's structure, policy, and physical environment. The authors describe these factors influencing PIF, then through the lens of PIF, describe approaches that programs and institutions have taken to address inclusivity by investing in the workforce, disrupting the hidden curriculum, revisiting policies and procedures, and examining the physical environment.The authors encourage programs, institutions, and the greater GME community to leverage each learning environment's unique strengths and root out challenges to enhance inclusivity for UIM trainees.

The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments.

Pediatric health inequities are pervasive and reflect the confluence of social and structural determinants of health including racism in all its forms. Current approaches in graduate medical education that prepare trainees to address health inequities and improve population health are inadequate. Competency based medical education (CBME) can advance equity-oriented efforts to improve patient outcomes, optimize the learning environment and encourage lifelong learning. We briefly describe the impact of racism and discrimination on the clinical learning environment. We then highlight how to apply the 5 core principles of CBME to equip learners across the continuum to address health inequities. We provide specific examples including 1) how CBME can inform teaching, assessment and professional development activities to promote equitable pediatric health outcomes via enturstable professional activities, 2) competency-focused instruction that address racism and inequities, 3) multimodal learning approaches to facilitate the acquisition of the desired competencies to address health inequities, 4) sequenced learning approaches across the continuum of practicing pediatricians, and 5) tools and resources for programmatic assessment of trainee and program performance in addressing pediatric health inequities.

Focused Team Engagements to Enhance Interprofessional Collaboration and Safety Behaviors among Novice Nurses and Medical Residents.

Background: Team communication remains a challenge in hospital settings. Hospital-based teams are diverse, team composition changes daily, and team members are frequently not co-located. Novice nurses and medical residents entering the workforce during the coronavirus 2019 pandemic experienced higher communication challenges than before and lacked adequate opportunities for interprofessional learning and communication. Method: We evaluated perceptions of safety and communication among novice nurses and medical residents after a 1-hour focused team engagement consisting of an interprofessional virtual simulation and debrief. We conducted a retrospective pre/post survey to measure perceptions of interprofessional collaboration using the Interprofessional Socialization and Valuing Scale. Results: Sixty-eight pediatric nurse residents and medical residents participated in the survey. Overall, the focused team engagements significantly improve participants' perceptions of interprofessional collaboration, with participants showing statistically significant improvement in seven of nine retrospective pre/post survey questions. When analyzing by discipline, nurse residents show stronger gains than medical residents. Conclusions: The interprofessional structured debriefings encourage nurses and medical residents to collaborate and discuss important safety topics away from bedside stressors. After completing the virtual simulation, the outcomes show improved perceptions of interprofessional collaboration and enhanced knowledge of safety techniques.

Diversity, Equity, Inclusion, and Justice in Medical Education: A Faculty Development Perspective.

As many residency programs expand teaching to address the knowledge, skills, and attitudes that residents need to dismantle structural racism and other systemic inequities, many faculty are not prepared to teach these topics. However, there is limited literature on which to base faculty development in this area. The aim of this article is to review how diversity, equity, inclusion, and justice education is integrated in pediatric faculty development efforts. This review will include published and gray literature on curricula and programs in medical education for faculty learners and will address common barriers and challenges faced by faculty members. [Pediatr Ann. 2023;52(7):e266-e272.].

Increasing Pediatric Residency Class Diversity to Improve Patient Outcomes and Address Structural Racism.

PROBLEM: The racial and ethnic makeup of physicians in the United States does not reflect that of the communities they serve. Addressing this disparity may improve patient outcomes and combat structural racism. APPROACH: Starting in 2014, the pediatric residency program at Children's National Hospital deliberately worked to assemble residency classes with racial and ethnic diversity that was similar to that of the Washington, DC, community it served. This work consisted of 3 initiatives: the Minority Senior Scholarship Program (MSSP), a pipeline program for rising fourth-year underrepresented in medicine (UIM) medical students to expose them to careers in academic pediatrics; an enhanced applicant recruitment process for UIM applicants; and mechanisms like a diversity dinner series for UIM residents to find the support they need to succeed. OUTCOMES: Since its inception in 2015, 73 participants have completed the MSSP, with 26% (19/73) going on to match at Children's National Hospital. An additional 12 participants are completing the program during the 2022 Match cycle. The MSSP has also increased participants' self-reported interest in pursuing a career in academic pediatrics, from 70% (14/20) before participation to 95% (19/20) after participation. In addition, the enhanced recruitment efforts have proven fruitful. The percentage of UIM interns at Children's National Hospital has increased from 5% (2/40) in 2014 to 51% (21/41) in 2021. NEXT STEPS: The dimensions of diversity included in these initiatives will be expanded to include individuals from other marginalized populations, such as certain individuals of Southeast Asian descent, those who identify as LGBTQ+, and those with disabilities. An antiracism initiative has also been implemented in the residency program in collaboration with the hospital and partner medical schools.

Inclusion and equity: Experiences of underrepresented in medicine physicians throughout the medical education continuum.

The mission of pediatric medical education is to train the workforce who will provide and innovate child healthcare, including addressing healthcare inequities for children and adolescents of color. A diverse physician workforce is associated with more equitable outcomes. Therefore, it is imperative that our workforce continue to reflect the ever-growing diverse nature of our society. While diversity has been at the forefront of conversations for increasing the number of underrepresented communities in medicine, inclusion and equity are oftentimes overlooked. It is crucial to recognize that while diversity is an important aspect to the UIM experience, the overall impact of diversity is diluted when it is not paired with inclusion and equity. Therefore, the purpose of this paper is to illustrate the experiences that shape inclusion and equity for UIM physicians along the training continuum and how negative factors may impact the wellness and career longevity of UIM physicians. Our study explored the experiences of UIM physicians throughout their medical education through the lens of inclusion and equity by exploring three common factors: social support, racism and discrimination, and well-being and burnout. There may be a perception that stressors, including racial discrimination, diminish with progression through one's educational career; however, this review suggests that these stressors manifest differently relative to the trials inherent to each career stage. By exploring the interplay between these factors and the UIM experience as a continuum, we are better able to discuss effective solutions to diversity, equity and inclusion for UIM physicians.

Factors that Influence Underrepresented in Medicine (UIM) Medical Students to Pursue a Career in Academic Pediatrics.

PURPOSE: The purpose of this study was to explore the experiences of medical students who are underrepresented in medicine (UIM) from two urban medical centers with an interest in pursuing academic pediatrics. METHODS: Focus groups were conducted at Children's National Hospital (CN) at three different times with UIM medical students from two urban medical centers. The investigator team was comprised of both junior and senior UIM and non-UIM pediatric academic faculty with experience in qualitative research. Twenty medical students UIM from Howard University College of Medicine (HUCM) and George Washington University School of Medicine and Health Sciences (GWSMHS) participated in the focus groups. The medical students targeted were first, second and fourth years to review experiences pre-and post-third year clerkships. RESULTS: Eighteen of the 20 students completed the demographic data of which 16 identified as Black/African-American. Fifteen of the participants were female and 3 were male. Findings indicated that mentorship, serving as role models, working with children and seeing UIM academic pediatricians positively influenced the students to pursue academic pediatrics. Family had a major influence on students' interest to pursue medicine. A barrier to pursuing academic pediatrics for UIM medical students included educational debt and lack of knowledge about the field. The students felt that there were fewer expectations of them during secondary school years which affected them throughout their journey to medical school. CONCLUSIONS: Early mentorship for UIM medical students is important to increase exposure to academic pediatrics. Future study on the experience of UIM medical students and their pursuit of academic roles could help produce a more diverse workforce. Also, pipeline programs for students to be exposed to academic pediatrics early in their education career would be beneficial.

Factors That Influence the Choice of Academic Pediatrics by Underrepresented Minorities.

OBJECTIVES: Our objective for this study was to explore the experiences of faculty in academic pediatrics who are underrepresented minorities (URMs) at 2 urban medical centers, in particular, the experiences that influenced their pursuit of academic pediatrics. METHODS: Three focus groups were conducted in 2016 with URM faculty from Howard University College of Medicine and Children's National Health System to explore how they were influenced to pursue academic pediatrics. Ten 1-on-1 interviews were also conducted in 2017 with URM faculty at Children's National Health System. Focus groups were coded and analyzed by the research team using standard qualitative methods. The 1-on-1 interviews were coded and analyzed by the primary investigator and verified by members of the research team. RESULTS: A total of 25 faculty participated in the study (15 in the focus groups and 10 in individual interviews). Eighteen of the faculty were women and 7 were men. Findings revealed that mentorship, family, and community influenced participants' career choices. Barriers for URMs in academic pediatrics included (1) lack of other URMs in leadership positions, (2) few URMs practicing academic pediatrics, and (3) the impact of racism and gender and implicit bias in the medical field. CONCLUSIONS: Mentorship and family are major influences on why URMs become academic pediatricians. Lack of URMs in leadership positions, racism, gender bias, and implicit bias are barriers for URMs in academic pediatrics. More research should be conducted on ways to enhance the experience of URMs and to reduce barriers in academia.

Children With Medical Complexity: A Web-Based Multimedia Curriculum Assessing Pediatric Residents Across North America.

OBJECTIVE: No standardized curricula exist for training residents in the special needs of children with medical complexity. We assessed resident satisfaction, knowledge, and behavior after implementing a novel online curriculum composed of multimedia modules on care of children with medical complexity utilizing virtual simulation. METHODS: We conducted a randomized controlled trial of residents across North America. A Web-based curriculum of 6 self-paced, interactive, multimedia modules was developed. Readings for each topic served as the control curriculum. Residents were randomized to 1 of 2 groups, each completing 3 modules and 3 sets of readings that were mutually exclusive. Outcomes included resident scores on satisfaction, knowledge-based assessments, and virtual simulation activities. RESULTS: Four hundred forty-two residents from 56 training programs enrolled in the curriculum, 229 of whom completed it and were included in the analysis. Subjects were more likely to report comfort with all topics if they reviewed modules compared to readings (P ≤ .01 for all 6 topics). Posttest knowledge scores were significantly higher than pretest scores overall (mean increase in score 17.7%; 95% confidence interval 16.0, 19.4), and the mean pre-post score increase for modules was significantly higher than readings (20.9% vs 15.4%, P < .001). Mean scores on the verbal handoff virtual simulation increased by 1.1 points (95% confidence interval 0.2, 2.0, P = .02). There were no significant differences found in pre-post performance for the device-related emergency virtual simulation. CONCLUSIONS: There was high satisfaction, significant knowledge acquisition, and specific behavior change after participating in this innovative online curriculum. This is the first multisite, randomized trial assessing satisfaction, knowledge impact, and behavior change in a virtually simulated environment with pediatric trainees.