<b>Algorithmic Hiring and Workplace Diversity: Evidence from a Zambian Private Sector Multinational</b>

Effective Tourism Stakeholder Collaboration and Member Satisfaction

Inequities in health are increasingly recognized across the country and globe.1,2 These inequities in morbidity and mortality stratify on demographic attributes, including race, ethnicity, gender identity, sexual orientation, ability, language status, and other factors individually and intersectionally.3–7 Anesthesiologists witness these health inequities across a broad range of practice areas and health care services.8–11 The root causes of healthcare inequities are multifactorial and operate at systemic and individual levels. At the systemic or structural level, biases built into policies, procedures, and practices influence the equity of healthcare delivery. These structural biases are often rooted in historical and sociopolitical discrimination, via varied mechanisms including differential access to healthcare;12,13 discriminatory policies and practices;9,14,15 and biased clinical reference standards.16–20 Implicit bias, in contrast, occurs at the individual level while also collectively influencing outcomes. Implicit bias may be linked to differential response to patient concerns, including time to evaluation,21,22 degree of diagnostic workup,21–24 clinical communication,25 access to referral,26 and/or access to treatment options,27 all ultimately influencing care outcomes. A diverse workforce is a necessary component in mitigating bias and inequity. The distribution of race, gender, and other demographics in the current healthcare workforce does not correspond to the overall patient population distribution.28–30 In academic anesthesiology, only 3% of the anesthesiologist workforce comprises Black or African-American physicians (versus 13% of the general population), and only 6% are from all races underrepresented in medicine (versus 34% of the general population).31–33 Women constitute 35% of academic anesthesiology faculty (compared to 50% of the general population).34 From 2009 to 2019, the number of ACGME-accredited pain fellowship programs increased by 14%; however, data reveals persistent gender and race disparities in the demographics of pain fellows.35,36 The root causes for workforce inequities mirror the causes of health inequities: structural and individual bias and microaggressions in the secondary and medical education pathways,37 as well as remnants of more explicit discriminatory policies and practices, such as sociopolitical segregation, educational segregation, and the residual impact of reports and legislation, e.g. the Flexner Report, which led to widespread closure of historically Black medical schools and strained the pathways for individuals of color to enter physician careers, with lasting impact.38–41 Not only is there prima facie value in a diverse, inclusive, and equitable workforce, there are also many reasons why workforce diversity positively influences healthcare outcomes, and conversely why lack of diversity contributes to healthcare outcomes disparities.33 Countless evidence-supported correlations have been identified regarding the benefits of workforce diversity on physician development and patient experience and outcomes. For physicians, some of these benefits include increased productivity and innovation,42 improved cognitive and affective development,43,44 and expanded breadth and depth of educational and research agendas.33,45 For patients, these benefits include improved clinician-patient communication,46–48 improved patient satisfaction and knowledge,49–53 increased academic focus on addressing disparities,33,45,54 improved access,50–52,55 and better quality of care and outcomes.46–48,55–61 The leak Even the apparent recent increases in healthcare workforce diversity obscure the magnitude of the current workforce disparity problem. While there have been modest increases in diversity in the healthcare workforce in aggregate, the proportion of individuals from backgrounds underrepresented in medicine ("URiM") consistently decreases at each level of advancement in medicine.31,62–66 In 2021, 1% of matriculants to United States medical schools identified as Native American or Alaskan Native, 11% identified as Black or African American, and 13% identified as Hispanic, Latine, or of Spanish origin.67 Women represented 55% of matriculants.67 In contrast, among 2021 anesthesiology residents, 0.1% identified as Native American or Alaskan Native, 5% identified as Black or African American, and 5% identified as Hispanic, Latine, or of Spanish origin. Only 33% identified as female and only one student identified as gender non-binary.68 A change in the proportions of race and gender representation from one level to the next reflects inequity, highlighting the "leak," so to speak. This gap further stratifies at the faculty level, where most URiM physicians in academic medicine, including anesthesiology, are at the instructor or assistant professor rank, and are underrepresented at higher ranks, including associate professor, professor, chair, associate dean, or dean.31,66,69–71 As stated previously, the driving factors for workforce and advancement inequities are historical injustices as well as ongoing systemic barriers to the success of URiM individuals, which may be modifiable or mitigated. These challenges include implicit biases in the advancement process,31,72–74 micro- and macroaggressions,37,75–77 deficiency of optimal mentors,31,78,79 disparate access and information regarding opportunities for advancement,74,79 disparate expectations (e.g., the "minority tax," the "glass ceiling," and the "glass cliff"),45,74,80–82 and other insidious factors. Herein, we will describe strategies for improving diversity and equitable representation in the anesthesiologist workforce, specifically by improving pathways and environments to enter and advance in anesthesiology. Although each individual whose identity includes one or more URiM demographic categories (e.g., race, gender identity, sexual orientation, et al) faces unique challenges, we will collectively explore common challenges and themes for any URiM individuals or groups. We will also describe examples from our experience implementing a strategic plan for this mission. Strategies range from readily accessible options for individuals committed to this cause, up to complex, resource-intensive program-building initiatives. Programmatic interventions Departmental, divisional, and training program leaders have numerous opportunities and imperatives to promote diversity, equity, and inclusion (DEI) in our field, particularly through focused recruitment and retention (fulfillment and advancement). Recruitment in this context means both the recruitment of anesthesia-bound URiM individuals to a particular institution and the recruitment of URiM individuals to pursue a career in duplicate the specialty of anesthesiology. "Retention" in this context goes beyond simply retaining individuals to stay in this field or at the institution; ensuring their development, fulfillment, advancement, and thriving is also crucial. Furthermore, this yields self-sustaining benefits, as a diverse, equitable, inclusive environment is one of the strongest tools for recruiting and retaining URiM individuals in an institution, department, or program. Advancement of any or all of the recommendations outlined throughout this work contributes to recruitment and retention, enhancing the more explicit guidelines mentioned below.29,83,84 Recruitment Equitable recruitment entails an equitable approach to all aspects of workforce recruitment – for all roles. In this section, we will discuss recommendations for the recruitment framework for any role, though many examples are most salient for the physician workforce. In graduate medical education, the recruitment process begins long before the application cycle, and we will discuss those seminal elements subsequently in the Pathways section. These recommendations include prioritizing outreach to URiM candidates, addressing systemic and implicit bias challenges at all stages of the recruitment process, diversifying the recruitment leadership, and fostering a data responsive environment. URiM-focused recruitment outreach Demonstrate valuing of URiM candidates through directed outreach – at Historically Black Colleges and Universities, through URiM-focused national societies and their conferences (e.g., Student National Medical Association, National Hispanic Medical Association, American Medical Women's Association, Medical Student Pride Alliance, Association of Native American Medical Students, National First Generation to Medicine Association (FGLIMed)), and via formal or informal networks and affinity groups. For faculty, consider engaging in cohort or cluster recruitment – recruitment of faculty in cohorts can promote a collective morale, with benefits in productivity, retention, and thriving.85 URiM-curated recruitment experiences Provide curated opportunities for URiM candidates to gain experience, exposure, and insights on the program, department, or institution. Dedicating rotation spots or scholarships for visiting electives in anesthesiology may be particularly valuable for individuals at medical schools not offering anesthesiology rotations for medical students and also for individuals with financial constraints. Faculty or resident ambassadors – who represent the program or institution and offer another insight into the institutional DEI culture – may be crucial in connecting URiM candidates with potential opportunities. URiM recruitment and "Second Look" events provide candid settings to learn about the environment, strengths, and challenges at the program or institution. However, these events should be designed with equitable access in mind and not create further disparity due to financial or other burdens. Publicizing DEI policies and mission statements explicitly may be helpful for prospective and current trainees, faculty, and staff because it implies institutional commitment and promotes culture and psychological safety. In order to hold weight, these stated policies must be matched by actual practice. Equitable and holistic candidate selection practices Approach candidate selection for interviews and candidate scoring and ranking equitably and holistically. In clerkships, disparities in clerkship grades and Medical Student Performance Evaluation summary words were found to favor white students over URiM or non-URiM minority students.86 One study found that most fourth-year medical student participants recalled being asked at least one potentially discriminatory interview question about their marital status, children, pregnancy plans, place of birth or national origin, religion, or ethnicity.87 Another study of resident selection found that Asian applicants had their personality less often discussed.88 Strategies to mitigate bias in the interview process might be including life-performance questions (e.g., leadership, community service, overcoming adversity, realistic self-appraisal, ability to recognize and navigate one's own bias, and ability to set goals and self-responsibility) and consistently asking the same questions to all participants.89 Addressing biased evaluation approaches and implementing alternative criteria may improve fairness and equity in assessment of candidate qualifications, and increase trainee diversity.90 Anti-bias training and awareness Everyone involved in the candidate recruitment and selection process must understand the value of the perspectives that URiM candidates bring to patient care and health equity, and the risks of those candidates being undervalued due to bias in the selection process. Not only have URiM candidates likely experienced systemic bias upstream that may influence their candidacy, they are also at risk of experiencing implicit bias during the application process. URiM candidates are at a higher risk of being subjected to interviewer bias, conscious or unconscious.83,91 Even the demographics conveyed (or presumed) in their written application can influence how their candidacy is perceived during interviewee selection and the eventual evaluation and ranking process. For example, a Harvard Business School research trial demonstrated that applications that had been "whitened" (i.e. revised by the researchers to exclude race-revealing data) were more than twice as likely to receive interview invitations than the same applications which preserved the data indicating that the applicant was Black or African-American.92 Implement specialized anti-bias training for those involved in the recruitment, interviewing, evaluation, and selection processes, in addition to the general anti-bias and cultural humility education that should exist at any institution.93 These training sessions should ideally be interactive, practical, expert-led, and tailored for the specific context or practice; simple click-through, self-study modules are not enough.94 Recruitment team diversity Diversify recruitment teams, and be mindful of the "minority tax,"80 i.e. the disproportionate utilization of URiM faculty without compensation to "represent" the institution in recruitment, mentorship, administrative, and other DEI-related positions in order to promote the appearance of a diverse institution. A diverse recruitment team can recruit a diverse workforce and is an accepted best practice for prioritizing diversity.95–97 However, URiM faculty career advancement can be hindered by expectations that they serve as diversity representatives in disproportion to non-URiM faculty. This disproportionate administrative burden on URiM, individuals though often well intentioned by leadership, comes at the cost of opportunities that lead to true career development and advancement activities.23 Time spent serving the DEI mission of the department, through recruitment or other avenues, should be appropriately recognized and built into a time-based or financial compensation structure.80,98,99 Data responsive environment Promoting a data-responsive environment requires that leadership identify, collect, evaluate, and respond to quantitative and qualitative data regarding the recruitment and selection processes, as well as the overall DEI environment at the program, department, or institution. For example, the influence of bias may be suggested by comparing the proportions of URiM to non-URiM individuals at each stage of the process: applicants, interview invitees, interviewees, new hires, promotions, and appointments to leadership roles. Metrics specific to graduate medical education recruitment may include the proportions of URiM to non-URiM individuals ranked to match, matched, advancing yearly, passing examinations, completing training, and ultimately achieving board certification if practicing. If there is a decrease in the proportion of URiM individuals from one stage to the next, systemic factors are likely contributory and should be explored in depth. This may include a more in-depth evaluation of, for example, how specific interviewers are rating individuals from different backgrounds, whether subtly biased language may be marked on URiM evaluations, and what events or metrics are cited in individual cases of promotion or advancement denial or delay.92,100,101 Collect qualitative data by engaging with individuals regarding the outcomes: find out why individuals chose to join the institution, but make equal effort to find out why others chose not to accept an interview invitation, chose not to rank to match, or chose not to accept a professional or academic position. Retention/thriving climate In addition to the recruitment-specific approaches, some needs must be addressed at a departmental or institutional level to promote the necessary characteristics of a thriving environment. As mentioned previously, "retention" goes beyond simply retaining individuals to stay in this field or at a particular institution, and requires ensuring their development, fulfillment, advancement, and thriving. Recommendations for promoting a diverse, equitable, and inclusive environment include explicit and compensated DEI leadership roles, committees, and departmental missions; high-quality anti-bias training; robust mentorship and sponsorship; directed, deliberate support; and fostering a data-responsive environment and safe culture. DEI leadership roles and committees Create leadership positions and DEI councils. Some institutions, such as the Mount Sinai School of Medicine, have reported success after a dedicated council was created to oversee early pipelines, outreach, and recruitment of URiM physicians, with representatives institution-wide.102 While a study in 2022 found that many anesthesiology departments had diversity and inclusion initiatives, only a few reported clearly defined leadership roles, which may hinder departmental success in promoting diversity.103 DEI leadership roles and activities should be compensated in a time-based or financial structure in order to recognize the value they provide to the institution, and ensure available time for the success of the efforts. DEI mission Define a departmental DEI mission that clearly prioritizes diversity, equity, and inclusion in patient care, research, education, innovation, and any other divisions of the department. While it is crucial to prioritize DEI in professional development as detailed here, there must be a parallel commitment to demonstrating this as a priority in these other domains for a comprehensively safe and positive environment. For example, perceiving an increased minority tax,99 witnessing microaggressions against patients of certain demographics,104 or noticing that health equity research is less valued in a department105 may undermine the morale of URiM faculty. Anti-bias training and health equity education Anti-bias training for all faculty and administrative leadership roles is imperative for creating an inclusive culture. As stated previously, this training must go beyond the ubiquitous and rote modules that accommodate learner multi-tasking.94 Intensive anti-bias training should be interactive and practically tailored to the audience. Anti-bias culture emanates from the examples set by leadership. Institutions benefit when key leaders are willing to interrogate their own biases and acknowledge the pervasive nature of bias and inequities even among progressive, well-intentioned individuals and institutions.106 In addition, developing a robust health equity education program may play a valuable role in increasing workforce diversity and promoting an inclusive culture – by serving as a recruitment tool, by elevating candidates from underrepresented backgrounds, and by broadcasting an institutional commitment to health equity.94,107,108 In our institution, several initiatives have been started, including sponsored electives in anesthesiology and health equity for visiting students, a health equity in anesthesiology and critical care curriculum for medical students, a longitudinal case-based health equity curriculum for anesthesiology residents, and a health equity seminar series for critical care fellows. Mentorship and sponsorship Mentorship and sponsorship are paramount. Early and direct access to invested mentors can elevate individuals in their careers and help achieve a more representative number of URiM anesthesiologists, particularly in leadership positions.109–113 Pairing junior URiM team members with qualified mentors and can to a to in their careers, through informal or direct to and other career development opportunities. is a at many of available URiM mentors for URiM and there will likely to be a workforce equity is While many individuals may a this may not be a realistic at most In many it may better serve to be with qualified even without demographic URiM faculty in promotion or Women and other URiM underrepresented in leadership and academic in academic anesthesiology, in professor, chair, and may influence the promotion and process who have experienced bias throughout their careers may be over for or be less likely to be for leadership positions or due to not to the same demographic or as those in positions of the value of URiM team members and ensure that the work of all is recognized appropriately the and institution. for and needs URiM by time and financial for these and a culture of can promote innovation, and increase Create and for and health care, financial and One is and programs for URiM fellows. A of 1% of for these initiatives had URiM and faculty promotion and increased programs and recruitment can inequities and for and URiM environment As for the recruitment process, program and departmental may provide opportunities to and mitigate bias and inequity. data may include demographics with evaluations, time to and other more of academic and/or clinical must be when these in order to at any or as opportunities for in program or departmental than further and by gender are and must to be data should be with invested the of on the potential for and of and potential In healthcare where is individuals may to about from team physicians or administrative because out can their professional tools the with of can be with to from individuals on domains of in and from URiM individuals at the institution to learn about barriers and challenges that may be the institutional culture. A study by the School of Medicine found that URiM faculty were less likely to that faculty recruitment was that and that they be at their current institution in resident events and of can the of any URiM trainee should be a and explored for opportunities to and prioritizing a data-responsive environment, leadership can to URiM team members that their is their are and leadership is willing to make necessary to improve the institutional environment and promote While the of URiM representation in academic anesthesiology in some with some metrics have to change (e.g., the distribution of and faculty appointments and been that diversity will at least to professional equity to the population achieve these individuals at level in the or institution must recognize the of the candidate and academic institutions, URiM can benefit from and at stages of their faculty recruitment, retention, and career advancement longitudinal at the work and levels. these strategies for increasing access to research, and URiM faculty can experience increased and through barriers and programs In a environment, DEI leaders may to new programs dedicated to improving pathways for URiM individuals to pursue careers in anesthesiology. to as are specialized initiatives designed to and students from underrepresented backgrounds to pursue and healthcare and and other unique In programs engaging students in and programs have positive outcomes for URiM students in several key including academic and into health medical these the at each stage of advancement, as detailed URiM representation at more junior at more levels. In order to promote and ensure diversity at all of a approach to programs may be at each advancing educational Although these programs have demonstrated impact at other educational and have the potential to elevate URiM success at the institutional level and at a national or At our institution, we the Pathways in in with the of and is a program to recruit and URiM medical students to pursue academic component of the program is designed to evidence-supported factors in URiM academic success and career Although there are many for a program, we this experience as a potential for other to or The program is of of and other on at for time and to on to medical student (e.g., and to correspond with key of the medical student The longitudinal nature students to with the program throughout their own advancement in medical training and to find to their The to of application and structural barriers and implicit and These sessions URiM students to the breadth of available to pursue in URiM individuals are underrepresented in more This may be due to including differential exposure, differential access to mentorship on application and implicit and structural bias in the application While the is less modifiable via a program, the program the other factors in the sessions of each the program all of the strategies for candidacy, and participants with potential mentors in these are interactive and sessions to in developing and their academic medical program includes sessions for each of medical such as time in medical for and and rotation for The are throughout the to for each medical student stage (e.g., in the and interview in the The overall includes as well as areas identified by in research on barriers to academic further the program are in advance of the program to any particular of is to program for their in for by numerous a may be specifically on this A of on rotation includes for mentorship, time a on the interview research, an match, and for fellowship or next In addition to the informal by the specialty and the of each program is dedicated to direct opportunities through the which or potential mentors and or selection invitations for valued with invitations for of the is while being mindful of the "minority program leaders for to be recognized and compensated on a time-based academic by the department. of the success of this program is the institutional and direct administrative from the of and the of Medical and the School of program with and and and implicit bias healthcare workforce and can impact health outcomes and success and workforce equity in anesthesiology must be a priority for healthcare program and individual and must be directed DEI that ensure more equitable access for URiM individuals to pursue anesthesiology training, in their careers, and into leadership in and these on race, gender, and other can be but these are critical for bias and While many of the interventions may be opportunities are available at level to the and make a positive impact on workforce We our recommendations can serve as a for anesthesiology leaders to DEI at their programs and and to URiM representation and success in the field of anesthesiology. an individual level, this means and to a more inclusive work environment. For anesthesiology training programs and advancing healthcare workforce equity requires comprehensively DEI data and addressing such as bias in recruitment and advancement, workforce education, and dedicated for and programs are a approach to elevate healthcare workforce equity in a an impact at the level may robust and and of the educational have an increased to promote about race, ethnicity, gender, orientation, ability status, and other factors. also have a professional and to systemic inequities and of bias in anesthesiology and medicine we recognize the of fostering diversity and equity in we to a for our our patients, and of that they have of

BackgroundThe development and evaluation of specific maternity care packages designed to address preterm birth remains a public health priority. We aim to evaluate the implementation, context, and potential mechanisms of action, of a new care pathway that combined midwifery continuity of care with a specialist obstetric clinic for women at risk of preterm birth (POPPIE) in London (UK).MethodsWe did a multiphase mixed method triangulation evaluation nested within a hybrid type 2, randomised controlled trial in London (United Kingdom). Pregnant women with identified risk factors for preterm birth were eligible for trial participation and randomly assigned (1:1) to either midwifery continuity of care linked to a specialist obstetric clinic (POPPIE group) or standard maternity care. The primary outcome was a composite of appropriate and timely interventions for the prevention and/or management of preterm labour and birth, analysed according to intention to treat. Clinical and process outcome data were abstracted from medical records and electronic data systems, and coded by study team members, who were masked to study group allocation. Implementation data were collected from meeting records and key documents, postnatal surveys (n = 164), semi-structured interviews with women (n = 30), healthcare providers and stakeholders (n = 24) pre-, mid and post implementation. Qualitative and quantitative data from meeting records and key documents were examined narratively. Qualitative data from interviews were analysed using three thematic frameworks: Proctor’s (for implementation outcomes: appropriateness, adoption, feasibility, acceptability, fidelity, penetration, sustainability), the Consolidated Framework for Implementation Research (for determinants of implementation), and published program theories of continuity models (for potential mechanisms). Data triangulation followed a convergent parallel and pragmatic approach which brought quantitative and qualitative data together at the interpretation stage. We averaged individual implementation measures across all domains to give a single composite implementation strength score which was compared to the primary outcome.ResultsBetween May 9, 2017, and Sep 30, 2018, 553 women were assessed for eligibility and 334 were enrolled with less than 6% of loss to follow up (169 were assigned to the POPPIE group; 165 were to the standard group). There was no difference in the primary outcome (POPPIE group 83·3% versus standard group 84·7%; risk ratio 0·98 [95% CI 0·90 to 1·08]). Appropriateness and adoption: The introduction of the POPPIE model was perceived as a positive fundamental change for local maternity services. Partnership working and additional funding were crucial for adoption. Fidelity: More than 75% of antenatal and postnatal visits were provided by a named or partner midwife, and a POPPIE midwife was present in more than 80% of births. Acceptability: Nearly 98% of women who responded to the postnatal survey were very satisfied with POPPIE model. Quantitative fidelity and acceptability results were supported by the qualitative findings. Penetration and sustainability: Despite delays (likely associated with lack of existing continuity models at the hospital), the model was embedded within established services and a joint decision was made to sustain and adapt the model after the trial (strongly facilitated by national maternal policy on continuity pathways). Potential mechanisms of impact identified included e.g. access to care, advocacy and perceptions of safety and trust. There was no association between implementation measures and the primary outcome.ConclusionsThe POPPIE model of care was a feasible and acceptable model of care that was implemented with high fidelity and sustained in maternity services. Larger powered trials are feasible and needed in other settings, to evaluate the impact and implementation of continuity programmes in other communities affected by preterm birth and women who experience social disadvantage and vulnerability.Trial registrationUKCRN Portfolio Database (prospectively registered, 24 April 2017): 31951.ISRCTN registry (retrospectively registered, 21 August 2017): ISRCTN37733900.

The rapid growth in the Banking industry has posed several challenges such as workplace diversity which is a natural phenomenon that has both negative and positive impacts on employee performance depending on how well it is managed. Studies have shown its management or mismanagement can affect the overall performance of the commercial banks in financial service sector. It is in this context and against this backdrop that this study explores the impact of Workplace Diversity proxied by Age diversity, Gender diversity, Ethnic Diversity, Income diversity, Education Diversity and Belief diversity on the dependent variable, employee performance proxied by the employee effectiveness. The study adopted a survey research design. While the study population consisted of all twenty-two Commercial Banks in Nigeria. A sample size of three hundred (300) respondents was selected. The internet mail survey had a 90% response rate. Data collection was by use of questionnaire through internet MS survey link. Analysis was by use of descriptive and inferential statistics in SPSS version 25.0. The Regression analysis coefficient indicated the strength and direction of relationship between each independent variables and the dependent variable and tested at 5% significance level. The study therefore concludes that workplace diversity variables like Gender diversity, Income diversity, Ethnic Diversity and Belief diversity have significant impact on the employee effectiveness thus their respective performance. However, Age and Educational diversity is found to be having no significant effect on performance of employees in the organization. The study was concluded with few recommendations and limitations. The study recommended that in order to leverage on the existing and observed diversity impact on employee effectiveness, the organizations need to begin to get conscious of why it is needful that they deal with demographic characteristics to gain a competitive advantage over competitors and stay competitive and make certain that great effort is taken to ensure that workers are properly informed of the present or existing initiatives and programmes of diversity and ensure to educate or train existing and newly employed employees on issues of diversity and its importance.

The rapid growth in the Banking industry has posed several challenges such as workplace diversity which is a natural phenomenon that has both negative and positive impacts on employee performance depending on how well it is managed. Studies have shown its management or mismanagement can affect the overall performance of commercial banks in the financial service sector. It is in this context and against this backdrop that this study explores the impact of Workplace diversity proxied by Age diversity, Gender diversity, Ethnic diversity, Income diversity, Education diversity and Belief diversity on the dependent variable, employee performance proxied by employee effectiveness. The study adopted a survey research design. While the study population consisted of all twenty-two Commercial Banks in Nigeria. A sample size of three hundred (300) respondents was selected. The internet mail survey had a 90% response rate. Data collection was by use of a questionnaire through the internet MS survey link. Analysis was done by use of descriptive and inferential statistics in SPSS version 25.0. The Regression analysis coefficient indicated the strength and direction of the relationship between each independent variable and the dependent variable and tested at a 5% significance level. The study, therefore, concludes that workplace diversity variables like Gender diversity, Income diversity, Ethnic diversity and Belief diversity have a significant impact on employee effectiveness thus their respective performance. However, Age and Educational diversity is found to be having no significant effect on the performance of employees in the organization. The study was concluded with few recommendations and limitations. The study recommended that to leverage the existing and observed diversity impact on employee effectiveness, the organizations need to begin to get conscious of why it is needful that they deal with demographic characteristics to gain a competitive advantage over competitors and stay competitive and make certain that great effort is taken to ensure that workers are properly informed of the present or existing initiatives and programmes of diversity and ensure to educate or train existing and newly employed employees on issues of diversity and its importance.

Autistic individuals face increased risk during police interactions in the United States, including injury and death. Research shows police behave inequitably during interactions with marginalized communities and may behave even more inequitably toward individuals with multiple minoritized identities. Many autistic people also identify as gender diverse. However, it is largely unknown if or how autistic adults' perceptions of police differ by gender identity. We examined autistic adults' perceptions of policing, autism, and gender using an online questionnaire. Results revealed significant differences across gender groups (cis women, cis men, gender diverse) in perceptions of justice, comfort in disclosing diagnosis, helpfulness of diagnostic disclosure, influence of gender, and concern that one's autistic traits would be misperceived as dangerous. These findings align with widespread calls for police reform and suggest current policing practices likely do not meet the needs of all autistic individuals, particularly autistic cis women and gender diverse individuals, who are more likely to report their gender has influenced police interactions and more concerned that their autistic characteristics are being misperceived, relative to autistic cis men. Reducing the harm marginalized groups face because of systemic inequities in the current policing system is a critical need that could enhance safety for autistic individuals.Lay abstractAutistic people in the United States are at a higher risk of injury or death when they interact with the police. Research has shown that police often treat people from minoritized communities unfairly, and this can be even worse for people who belong to more than one minoritized group, like being both autistic and gender diverse. Many autistic people also identify as gender diverse. However, we do not yet know if autistic people's views of police may differ across gender identities. In this study, we explored how autistic adults view police and if those views differ across different gender identities. We found that autistic adults with different gender identities have different views on things like justice, how comfortable they feel telling police about their autism diagnosis, whether they think telling the police about their diagnosis would be helpful, how they think their gender affects police behavior, and whether they worry that their autistic traits might be seen as dangerous. These results may indicate that the current policing practices may not take into account autistic individuals' unique perspectives and experiences, particularly when police are interacting with autistic women and gender diverse people. It is important that we make changes to reduce the harm that autistic people face because of unfairness in the current policing system using feedback from autistic individuals. This could make things safer for all autistic people. Our results suggest it could be beneficial for police officers to receive training that is inclusive of the gender diversity within the autistic community, so they can better protect and respect all autistic people.

Reflective teaching, which has gained popularity and reattracted scholarly interest recently, can help practitioners of education gain new insights into their own practices by questioning their underlying assumptions, habits and perspectives and taking broader societal and political implications of their teaching. In a world where change has become an undeniable aspect of daily life, reflective teaching is particularly important considering its possible far-reaching contributions to the overall quality of teaching. Grounded in a mixed method embedded design, the current study was carried out to explore (1) overall levels of reflection of the participants, (2) whether certain variables (gender, degree, experience, certification and department) have an influence on the participants’ levels of reflection, (3) how reflection takes place, (4) what tools of reflection are employed by the participant. For the current study, the quantitative data was collected through the Reflective Teaching Questionnaire developed by Larrivee (2008). The questionnaire was administered to 100 instructors employed in the foreign languages departments of eight foundation universities in Turkey. The data obtained were analyzed using SPSS (26) for Windows. The qualitative study followed the quantitative phase and was carried out with the participation of 10 instructors in one of the foundation universities. The qualitative data was collected through the semi-structured individual interviews and content-analyzed by the researcher manually. The findings revealed that the participants’ perception of their reflection levels were positive. The results indicated that the majority of the participants reflected on their teaching pedagogically or critically, though in many cases the variables of the study did not seem to significantly affect their levels of reflection. The qualitative findings also indicate that reflection takes place before, during or after teaching, and diverse reflection tools are used by the participants. The qualitative findings also indicate that there are some contextual factors inhibiting or enabling reflection such as strict curriculum, workload, work environment and flexibility. When both the qualitative and quantitative data are considered together, it seems that the participants’ perception of their reflective practices are positive, but it is also clear from the results that reflection does not happen in a systematic and organized way. Finally, it is noteworthy to state that reflection levels seem to be dependent most on individual factors and choices, regarding that such variables as degree, experience, certification and experience often did not significantly impact reflection levels. To conclude, the present study contributes modest insights into reflective teaching practices in higher education ELT/EFL settings. Acknowledging the positive implications of reflection, the findings of the study related to how reflection takes place and what tools are used can help both researchers and practitioners in the field understand reflective teaching better.

Objectives:Physician ethnic and gender diversity is known to be inextricably linked to patient outcomes, access to care and healthcare literacy in underrepresented patients. Despite this knowledge, the ethnic and gender disparities prevalent amongst physicians continue to contribute to inequalities in the American healthcare system. Recent data has demonstrated that surgeons, with orthopaedic surgeons in particular, are amongst the least diverse group of physicians. There has been an increased emphasis on promoting surgeon diversity as well as an increased emphasis on publishing literature regarding diversity. Through a systematic review of the literature regarding diversity throughout all surgical subspecialties, this study aims to determine whether this recent increased awareness has correlated to an increase in the number of publications on the matter. This study also aims to quantify the literary contributions of each surgical subspecialty and correlate this with each subspecialties respective demographic profile to identify areas that can be improved in order to continue to promote diversity.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to query articles from PubMed, Embase, Web of Science and the Cumulative Index to Nursing and Allied Health Literature through April 1st, 2022. The search used a combination of keywords for the constructs of surgical subspecialties, residency training and diversity. The Rayyan Intelligent Systematic Review program was then utilized by three independent reviewers to screen articles. Broad inclusion criteria was utilized to include articles that discussed either ethnic or gender diversity as it pertained to any surgical subspecialty. Articles that only discussed diversity in non-surgical medical fields or articles that only discussed diversity related to religion, age, or sexual orientation were excluded. Articles were then categorized by surgical subspecialty, type of diversity discussed (gender, ethnic or both) and level of training.Results:The query resulted in 1429 total articles from 4 database searches. 408 duplicate articles were found and removed. Of the remaining 1021 articles screened, 701 were excluded with the remainder of the 320 studies included in the review (Figure 1). Orthopaedic surgery was the subspecialty with the highest number of publications regarding ethnic or gender diversity (n=73), followed by general surgery (n=56) (Figure 2). A majority of articles focused solely on gender diversity (n=144) with fewer articles focusing solely on ethnic diversity (n=39). A total of 137 articles analyzed both ethnic and gender diversity. Figure 3 illustrates the number of studies about diversity published by year dating back to 1998. A total of 109 studies regarding surgical diversity were published in 2021 compared to just 22 studies during a 10 year period from 1998 to 2007 (Figure 3). Two articles were published prior to 1998 and 17 articles have been published in 2022 prior to April 1st, 2022. A total of 221 reports discussed ethnic or gender diversity at the resident level, 41 studies at the fellow level and only 20 studies at the student level.Conclusions:The importance of promoting diversity in surgeons cannot be overstated. Improved patient satisfaction, better patient outcomes, greater access to healthcare and more transparent patient- physician communication are but a few of the tangible benefits of having a diverse workforce. Orthopaedic surgery is the surgical subspecialty with the most publications regarding diversity amongst surgeons. While orthopaedic surgery should be commended for this, it remains one of the least ethnically and gender diverse surgical subspecialties. This review highlights the need for orthopaedic surgeons to continue to promote diversity at all training levels. Furthermore, as the recent emphasis on promoting diversity has led to a rapid increase in published studies in recent years, close attention should be paid to how the ethnic and gender landscape of the surgical workforce changes over the coming years. There were more than ten times the number of articles discussing diversity at the resident level compared to at the medical student level. Should gender and ethnic diversity remain stagnant, surgeons may need to place increased emphasis on targeting a younger demographic and continue to implement more grassroots programs that promote ethnic and gender diversity.

Making sexual diversity visible through LGTBIQ+ teachers’ life stories: A descriptive study

This study examines the impact of workplace diversity in Nepalese organizations. Organizational performance is selected as the dependent variable. Similarly, age diversity, gender diversity, ethnic diversity, educational background diversity and marital status diversity are selected as the independent variables. This study is based on primary data with 123 observations. To achieve the purpose of the study, structured questionnaire is prepared. The correlation coefficients and regression models are estimated to test the significance and importance of different factors influencing workplace diversity in Nepalese organizations. The study showed that that age diversity has a positive impact on organizational performance. It means that increase in age diversity in organization leads to increase in organizational performance. Similarly, gender diversity has a positive impact on organizational performance. It means that increase in gender diversity in an organization leads to increase in organizational performance. Moreover, ethnic diversity has a positive impact on organizational performance. It means increase in ethnic diversity in an organization leads to increase in organizational performance. Likewise, marital status diversity has a positive impact on organizational performance. It means that increase in marital status diversity in an organization leads to increase in organizational performance. Further, educational background diversity has a positive impact on organizational performance. It implies that increase in educational background diversity in an organization leads to increase in organizational performance.

BackgroundTourists are at risk of experiencing health problems during their travel. However, even though tour guides have the potential to become travel health promoters, their participation has not been optimal.ObjectiveThis study aims to develop a comprehensive travel health education model to help tour guides improve health information delivery to tourists.MethodsThis is an exploratory sequential mixed methods research. The first phase consisted of a qualitative study with an informed grounded theory design. In-depth interviews were carried out with tour guides from all language divisions and policymakers of the Indonesian Tour Guide Association Bali Branch or Himpunan Pramuwisata Indonesia Daerah Bali (HPI Bali). The interview guidelines were developed based on the theory of planned behavior and identity theory. Qualitative data were analyzed thematically. In the interim phase, a travel health education model and questionnaire were developed based on the qualitative findings. The initial model and its instruments were finetuned after consultation with travel medicine and health promotion experts. Furthermore, the validity and reliability of the questionnaire were tested on 30 tour guides. The second phase consisted of a quantitative study with a randomized pretest-posttest control group design. A total of 76 tour guides in the intervention group received comprehensive travel health education, while 76 in the control group received no specific intervention. Outcome variables (ie, attitudes, subjective norms, perceived behavioral control, actual behavioral control, role identity, and behavioral intention) were measured at baseline (T0), after the online training (T1), before information sharing via WhatsApp (T2), a month after the start of the WhatsApp intervention (T3), and at the end of the WhatsApp intervention (T4). The mean difference of each outcome variable before and after the intervention will be compared between the intervention and control groups. Thereafter, the quantitative and qualitative findings will be integrated into a joint display.ResultsThe qualitative phase was conducted through in-depth interviews with 21 informants who included tour guides and policymakers from HPI Bali from May to June 2021. The education model, educational materials, and questionnaire were developed based on the qualitative findings and consultation with experts. The education model consists of online training and information sharing through WhatsApp and was trialed with tour guides from November 2021 to February 2022. As of April 2022, this study is in the quantitative data analysis stage.ConclusionsA travel health education model was developed based on qualitative findings and consultation with experts. The model was tested with tour guides, and a series of self-administered questionnaires were completed. This study is in the quantitative data analysis stage and will continue by integrating qualitative and quantitative findings into a joint display.Trial RegistrationClinicalTrials.gov NCT04961983; https://clinicaltrials.gov/ct2/show/NCT04961983

<p style="text-align:justify">The present study aimed to provide a digital story development experience for pre-service science teachers in the “instructional technologies and material development” course and to determine the impact of these experiences on their views on digital storytelling. Simultaneous parallel design, one of the mixed methods in which both quantitative and qualitative data were collected, was used in the study. Quantitative and qualitative findings are presented in different sections and both were interpreted in the discussion section. The quantitative study data were collected from 50 pre-service teachers, while the qualitative data were collected from 16 pre-service teachers. Quantitative data were collected by a survey and the qualitative data were collected in interviews. Descriptive/inferential statistics were employed in the analysis of the survey data. The steps of the analysis, coding, and categorization were adopted in the study for qualitative data. The positive effect of digital storytelling on the 21st-century skills of pre-service teachers was revealed by both quantitative and qualitative data. Furthermore, it was determined that pre-service teachers considered digital storytelling as advantageous since it provided meaningful and permanent learning, was fun and motivational; however, it also had disadvantages since it was time-consuming and required technological knowledge. It was revealed that they experienced certain difficulties in scriptwriting, finding the related images/videos and photographs, and finalizing the recording, and they considered that most, if not all, topics in the science course were suitable for digital storytelling. For pre-service teachers to acquire 21st-century skills, digital storytelling should be employed in several courses including the teaching practice course, and pre-service teachers should gain experience in preparing the students for digital storytelling.</p>

Workplace violence, commonly known as WPV, was a prominent occurrence, particularly within the healthcare environment. The occurrence of workplace violence (WPV) targeting healthcare workers (HCWs) had witnessed a surge amidst the COVID-19 pandemic. The aim of the study was to develop triphasic methods by exploring the intended anti-workplace violence interventions among healthcare institutions, specifically hospitals in Batangas. This investigation utilized a three-phase research design that aimed to undertake an analysis of both qualitative and quantitative data to create a bespoke questionnaire pertaining to the efficacy of anti-violence measures in the healthcare workplace. An exploratory sequential design encompassed a research methodology that integrated both qualitative and quantitative methods. In this particular study design, the sequential steps involved the initial collection and analysis of qualitative data followed by the subsequent collection and analysis of quantitative data. Salvador et al. (2020) employed a three-stage exploratory sequential mixed-methods strategy. In phase one, the researchers conducted semi-structured qualitative interviews with 20 nurses. The Colaizzi approach was used to examine the data collected from these interviews. In phase two, the qualitative findings were converted into survey components, constructs, and items. The nursing process system concept was used to develop this new survey instrument. Finally, in phase three, validation was done to formally approach an extensive program tool that emphasized anti-violence. The aimed of the studied was to explore the workplace violence experienced by nurses in hospitals to provided a strategic intervention thus, this was implemented among hospitals in Batangas. Hospitals was classified according to functionality, known to acknowledged all kinds of illnesses, deformities, or diseases. The local context provided insights and statistics that was directly pertinent to the country's healthcare system and nursing staff. It assisted in addressing specific difficulties and needed faced by Filipino nurses and healthcare facilities. There had been incidents and reports of workplace violence, and knowing the precise elements that contributed to violence in this setting led to more targeted interventions and solutions. The variety of healthcare settings and the availability of resources was also factors in selecting Batangas province.

Gender representation in textbooks has a powerful impact on students’ perceptions and social identities. Unbalanced gender portrayal can influence how students view their roles and opportunities in society. This study aimed to investigate how gender is represented in educational material, English for Nusantara textbook for eighth-grade students. A mixed-method design was employed, combining content analysis and discourse analysis, to examine how often male and female characters are represented in the textbook. Brugeilles and Cromer's (2009) model was employed to inform analysis, focusing on the frequency of activities, roles, and characters' appearances. The findings revealed that male and female characters appear in nearly equal numbers however traditional gender roles are still dominated. Male characters are more frequently depicted in physical, competitive, and public roles, such as workers and rescuers, while female characters are more often shown in domestic, educational, and cultural contexts. These findings suggest that numerical balance does not necessarily indicate gender equality in representation. The study highlights the need for more diverse and equitable representation of both genders in educational materials. It also suggests that future research explores students' perceptions of gender and how teachers address gendered content in classroom settings to support more inclusive English language learning.

IntroductionAdvances in antiretroviral therapy have transformed HIV into a long-term condition with near-normal life expectancy for those in whom viral replication is well controlled on treatment. This means that age-related...