Gender Communication Differences on a Pediatric Provider Listserv.

BACKGROUND AND OBJECTIVES: Gender-based communication differences are described in educational online communities, but have not been rigorously evaluated in medical online communities. Understanding gender differences in communication may provide insight into gender disparities in the medical profession. Our objective was to describe gender differences in post frequency, content, and language styles on the American Academy of Pediatrics Section on Hospital Medicine (SOHM) listserv. METHODS: Posts were obtained from publicly available SOHM listserv archives. The first month of every quarter of 2019 and 2020 were reviewed. Two reviewers assigned a post topic (clinical, research, etc) and format (question vs statement) to all deidentified original posts (K = 1.0 topic, 0.89 format). Six trained reviewers assigned language styles (intraclass coefficient = 0.73, indicating good agreement). RESULTS: We analyzed 1592 posts: 287 original posts and 1305 responses. Frequency: Women authored 50% of posts. The 9 most frequent posters (7 men, 2 women) accounted for 19.5% of posts. Content: Men's posts had more words than women's (132.51 vs 112.3, P ≤ .01). Men were more likely to post about health policy and research (P < .001). Men were more likely to post statements compared with women (39% vs 21%, P < .001). Style: Men's posts were more likely to be coded adversarial (12.3% vs 5.5%, P < .001) authoritative (12.2% vs 6.5%, P < .001) or self-amplifying (6.5% vs 3.6%, P < .001). CONCLUSIONS: Women contribute disproportionately fewer posts to the American Academy of Pediatrics SOHM listserv compared with their percentage in the subspecialty. We noted significant gender differences in language style and content, which may impact career development and online community inclusion.

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.

"The curriculum brings equity to the forefront": Pediatric residents' perspectives and experiences in a longitudinal EDI curriculum.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements include training in caring for diverse populations and understanding social determinants of health. Our large pediatric residency program implemented a longitudinal equity, diversity and inclusion (EDI) curriculum. OBJECTIVE: To explore pediatric residents' perspectives and experiences in our longitudinal EDI curriculum. METHODS: We applied the holistic framework by Haji et al. to characterize the effect of our EDI curriculum. We conducted 4 focus groups from November 2019 to September 2020 with trained facilitators using a structured question guide. We approached all eligible senior residents (n = 87) via email to participate. Project members coded written notes and transcripts and analyzed data using inductive thematic analysis. RESULTS: 26 pediatric senior residents participated either in person (n = 13) or online (n = 13). Themes emerged from domains of knowledge, attitudes and behavioral change. These included having: (1) increased knowledge surrounding EDI issues, (2) a framework and language to better engage in EDI efforts and (3) increased confidence interrupting bias and microaggressions. Additional themes demonstrated: an increased need for EDI education at the institutional level, the unique experiences of Black, Indigenous, People of Color (BIPOC) trainees, and systemic barriers to equitable care. CONCLUSION: A longitudinal EDI curriculum has the potential to influence individual trainees, their work, and perceptions of the broader institutions in which they operate. Residents recognized and valued the curriculum and felt driven to use this knowledge to ensure that institutional policies and practices led to equitable clinical care.

Use of Race in Pediatric Clinical Practice Guidelines: A Systematic Review.

Importance: National clinical practice guidelines (CPGs) guide medical practice. The use of race in CPGs has the potential to positively or negatively affect structural racism and health inequities. Objective: To review the use of race in published pediatric CPGs. Evidence Review: A literature search of PubMed, Medscape, Emergency Care Research Institute Guidelines Trust, and MetaLib.gov was performed for English-language clinical guidelines addressing patients younger than 19 years of age from January 1, 2016, to April 30, 2021. The study team systematically identified and evaluated all articles that used race and ethnicity terms and then used a critical race theory framework to classify each use according to the potential to either positively or negatively affect structural racism and racial inequities in health care. Findings: Of 414 identified pediatric clinical practice guidelines, 126 (30%) met criteria for full review because of the use of race or ethnicity terms and 288 (70%) did not use race or ethnicity terms. The use of a race term occurred 175 times in either background, clinical recommendations, or future directions. A use of race with a potential negative effect occurred 87 times (49.7%) across 73 CPGs and a positive effect 50 times (28.6%) across 45 CPGs. Conclusions and Relevance: In this systematic review of US-based pediatric CPGs, race was frequently used in ways that could negatively affect health care inequities. Many opportunities exist for national medical organizations to improve the use of race in CPGs to positively affect health care, particularly for racial and ethnic minoritized communities.

Grounded in Justice: An Equity Framework for Chief Residents.

The 2019-2020 academic year was unprecedented, with navigating the COVID-19 pandemic and meaningfully engaging with the causes and consequences of long-standing racism and social injustice in the United States. In this article, the authors, all former chief residents, reflect on how they carried out their role during this last year using an approach that was grounded in equity and justice. They describe a framework based on their experiences, including setting the tone and culture of the residency program; providing medical education, teaching, and feedback; advocating for resident well-being and inclusion; participating in quality improvement and hospital policymaking; and partnering for institutional change. They end with a call to action to reconceptualize the role of the chief resident to include the genuine work of diversity, equity, and inclusion to ensure a more equitable future.