Original Article

Evaluation of the Diversity, Equity, and Inclusion Curriculum of a Pediatrics Residency Program

Authors: Matthew S. Hazle, MD, Monica L. Hoff, MD, Claudia Mosquera Vasquez, MD, Elizabeth M. Bonachea, MD, Stephanie M. Lauden, MD, CTropMed, Jason Benedict, MS, Michael F. Perry, MD


Objectives: Diversity, equity, and inclusion (DEI) training is essential to graduate medical education, but it lacks standardization. Although the impact of providers’ biases and cultural competency on patient outcomes is well documented, the value of and satisfaction with DEI curricula in Pediatrics residency training programs is not well studied. This study aimed to complete a cross-sectional evaluation of the current DEI curriculum at a large Pediatrics-focused academic institution and identify areas of perceived deficiency among Pediatrics trainees.

Methods: Residents and residency program directors completed surveys in 2020. Respondents evaluated the DEI curriculum of the program and the competency of residents to complete patient care related to specific DEI-oriented actions. Our analysis used descriptive statistics.

Results: In total, 48 of 137 resident trainees (35%) and 7 of 9 program leaders (78%) completed the survey. Respondents were most dissatisfied with current education related to implicit bias, refugee/immigrant health, and lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other health topics. Respondents reported low resident competency in DEI-focused patient care tasks and did not view residents as competent to address the healthcare needs of patients and families experiencing racism.

Conclusions: Pediatrics residents and program directors consider DEI topics important and express a need for more robust DEI curricula.

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1. Johnson TJ, Ellison AM, Dalembert G, et al. Implicit bias in pediatric academic medicine. J Natl Med Assoc 2017;109:156–163.
2. Raphael JL, Oyeku SO. Implicit bias in pediatrics: an emerging focus in health equity research. Pediatrics 2020;145:e20200512.
3. Johnson TJ, Weaver MD, Borrero S, et al. Association of race and ethnicity with management of abdominal pain in the emergency department. Pediatrics 2013;132:e851–e858.
4. Goyal MK, Chamberlain JM, Webb M, et al. Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Acad Emerg Med 2021; 28:949–956.
5. Goyal MK, Kuppermann N, Cleary SD, et al. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr 2015;169:996–1002.
6. Sabin JA, Greenwald AG. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health 2012;102:988–995.
7. Ambrose AJ, Lin SY, Chun MB. Cultural competency training requirements in graduate medical education. J Grad Med Educ 2013;5:227–231.
8. Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev 2000; 57(Suppl 1):181–217.
9. Smith WR, Betancourt JR, Wynia MK, et al. Recommendations for teaching about racial and ethnic disparities in health and health care. Ann Intern Med 2007;147:654–665.
10. Trent M, Dooley DG, Dougé J. The impact of racism on child and adolescent health. Pediatrics 2019;144:e20191765.
11. White Coats for Black Lives (WC4BL) National Working Group. #BlackLivesMatter: physicians must stand for racial justice. AMA J Ethics 2015;17:978–982.
12. Fu J, Reid SA, French B, et al. Racial disparities in COVID-19 outcomes among Black and White patients with cancer. JAMA Netw Open 2022;5: e224304.
13. Kirby T. Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. Lancet Respir Med 2020;8:547–548.
14. Oppel RA Jr, Gebeloff R, Lai KKR, et al. The fullest look yet at the racial inequality of coronavirus. https://www.nytimes.com/interactive/2020/07/05/us/coronavirus-latinos-african-americans-cdc-data.html. Published July 5, 2020. Accessed June 19, 2022.
15. Tsai JW, Michelson CD. Attitudes toward implicit bias and implicit bias training among pediatric residency program directors: a national survey. J Pediatr 2020;221:4–6.e1.
16. Jindal M, Thornton RL, McRae A, et al. Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy. J Grad Med Educ 2022;14:407–413.
17. Karvonen KL, Menjívar-López JS, Brissett D, et al. A resident-led initiative to advance diversity, equity, inclusion, and antiracism in a pediatrics residency program. Acad Pediatr 2022;22:360–364.
18. Mullett TA, Rooholamini SN, Gilliam C, et al. Description of a novel curriculum on equity, diversity and inclusion for pediatric residents. J Natl Med Assoc 2022;113:616–625.
19. Chen BY, Kern DE, Kearns RM, et al. From modules to MOOCs: application of the six-step approach to online curriculum development for medical education. Acad Med 2019;94:678–685.
20. Girod S, Fassiotto M, Grewal D, et al. Reducing implicit gender leadership bias in academic medicine with an educational intervention. Acad Med 2016; 91:1143–1150.
21. Kirwan Institute. State of the science: implicit bias review. 2016 edition. https://culturalq.com/wp-content/uploads/2019/03/Kirwan-Institute-Implicit-Bias-2016-report.pdf. Published 2016. Accessed June 19, 2021.
22. Xu FK, Nosek BA, Greenwald AG, et al. Skin tone IAT 2004-2022. Experiment materials. https://osf.io/6j7f2/. Accessed February 9, 2020.
23. Holroyd J. Implicit bias, awareness and imperfect cognitions. Conscious Cogn 2015;33:511–523.
24. Weissman JS, Betancourt J, Campbell EG, et al. Resident physicians' preparedness to provide cross-cultural care. JAMA 2005;294:1058–1067.
25. Barber Doucet H, Ward VL, Johnson TJ, et al. Implicit bias and caring for diverse populations: pediatric trainee attitudes and gaps in training. Clin Pediatr (Phila) 2021;60:408–417.
26. Rule ARL, Reynolds K, Sucharew H, et al. Perceived cultural competency skills and deficiencies among pediatric residents and faculty at a large teaching hospital. Hosp Pediatr 2018;8:554–569.
27. Blumenthal D, Gokhale M, Campbell EG, et al. Preparedness for clinical practice: reports of graduating residents at academic health centers. JAMA 2001;286:1027–1034.
28. Weissman JS, Campbell EG, Gokhale M, et al. Residents' preferences and preparation for caring for underserved populations. J Urban Health 2001; 78:535–549.
29. Mendoza FS, Walker LR, Stoll BJ, et al. Diversity and inclusion training in pediatric departments. Pediatrics 2015;135:707–713.
30. Agency for Healthcare Research and Quality. 2022 National Healthcare Quality and Disparities Report. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr22/index.html. Accessed June 5, 2023.
31. Stone VE. White coats for Black lives: the time has come for action. Ann Intern Med 2020;173:656–657.
32. Kelly S, Jeremie-Brink G, Chambers AL, et al. The Black Lives Matter movement: a call to action for couple and family therapists. Fam Process 2020; 59:1374–1388.