Diverse Residents Research Articles

Diversity, Equity, and Inclusion Efforts in Graduate Medical Education: Identifying Opportunities for Collaborative Learning.

Background Physician-patient racial and cultural concordance is essential to address health care disparities. Yet, limited literature on diversity, equity, and inclusion (DEI) outcomes in graduate medical education (GME) suggests the need for high-yield DEI resources. Objectives To describe and identify DEI efforts by US residency program director (PD) associations and areas for collaboration among the GME community. Methods Through bimonthly teleconferences and 5 iterative revisions from June to September 2022, the DEI workgroup of the US Organization of PD Associations developed a 17-question needs assessment survey to investigate DEI activities across residency PD associations, which was delivered twice electronically from September to November 2022 to 30 specialty PD association representatives. Results Survey response rate was 73% (22 of 30). Specialties track resident demographics more than PD demographics (11 of 22, 50% vs 7 of 22, 32%). Tracked demographics vary and include race, gender, and sexual orientation. Most PD associations have DEI committees (16 of 22, 73%) implementing various initiatives, the most common of which was providing resources to ensure diverse representation (11 of 16, 69%). Most specialties provide residency recruitment resources (14 of 22, 64%) and funding for visiting rotations or mentorship for underrepresented trainees (12 of 22, 54%). Resources for pipeline programs (7 of 22, 32%) and retention of diverse residents (7 of 22, 32%) were less common. Faculty development training focused more on teaching DEI to residents (14 of 22, 64%) than on teaching health disparities (7 of 22, 32%). Conclusions Our study demonstrates substantial DEI interventions among specialty PD associations. Yet, educational gaps exist in specific DEI content, faculty development, and curricular dissemination.

General emergency physician perceptions of caring for children: A qualitative interview study.

Emergency physicians care for most children presenting to U.S. emergency departments (EDs). Pediatric exposure during emergency medicine (EM) residency can be variable and critically ill children are rarely encountered. A recent needs assessment revealed that emergency physicians feel less prepared to manage various conditions in children and that infants, regardless of presenting complaint, pose particular challenges. Emergency physician perceptions of the experience of caring for pediatric patients have not been widely examined through a qualitative lens. We designed an interview-based qualitative study to explore emergency physician perspectives on pediatric patient care. We recruited emergency physicians who graduated from residency in 2015-2019 and all rotated through the same large tertiary children's hospital. Four trained interviewers conducted in-depth, one-on-one virtual interviews. An interdisciplinary team transcribed and then coded the interviews. The team performed a conventional content analysis for themes. Recruitment continued until thematic saturation was achieved. Twelve participants completed interviews. These participants trained in five diverse residency programs. Likewise, the participants now practice in a variety of settings. Three major themes emerged from the data: (1) experience and exposure are key to establishing comfort caring for children; (2) simulation, pathways, and the pediatric anesthesia rotation are educationally useful; and (3) caring for children poses unique emotional challenges. Participants shared many recommendations for future pediatric education for EM trainees, including increasing autonomy and exposure to neonates and considering how care might differ in a community setting. This interview-based qualitative study elucidates key themes in recently graduated emergency physicians' perceived experience of caring for children. Our findings have important educational implications for this group of emergency physicians and those who share similar experiences in training and practice.

Case-Based Peer Teaching for Pain Medicine Fellows: A Curriculum for Diverse Residency Backgrounds.

Pain medicine is an advanced medical subspecialty incorporating trainees from diverse primary disciplines. A curriculum that does not assess or promote the trainees' differential expertise developed from their primary specialties may silo instead of promoting collaborative learning in a multidisciplinary subspecialty. We created a Kern-guided curriculum for the pain medicine fellowship utilizing case-based modules and a novel note-taking and knowledge-sharing format. Nine faculty-led, case-based modules of increasing complexity were developed based on pain medicine competency content. Pain medicine fellows were instructed to actively designate prior and new knowledge into four categories: Prior knowledge that is accurate and relevant, inaccurate prior knowledge, new knowledge gained from peers, and new knowledge for all trainees. After each case study, each fellow acknowledged "new knowledge gained from peers" and prepared a brief teach-back of "new knowledge for all trainees" at the beginning of the next session. Fellow participants were assessed for their reactions to the curriculum via anonymized surveys. The curriculum was implemented at a single institution pain medicine fellowship from 2021 to 2023. At the end of this curriculum, 90% of participants reported improved knowledge retention through participating in this case-based curriculum compared to the traditional didactic format, and 80% participants reported increased respect for their peers. We created a novel note-taking and knowledge-sharing platform, anchored by a well-established case-based educational strategy, to improve the learning environment and knowledge retention for multidisciplinary trainees with heterogeneous baseline knowledge.

Improving Diversity in a Rural Academic Obstetrics and Gynecology Training Program

Both the Accreditation Council for Graduate Medical Education and the American College of Obstetricians and Gynecologists advocate for greater diversity within our workforce, which starts with recruiting and retaining a diverse residency pool. Historically, applicants who are underrepresented in medicine have been more likely to apply to residency programs located in urban locations, as opposed to a rural training environment. In this commentary, we discuss a novel strategy used to attract underrepresented in medicine applicants to a rural academic obstetrics and gynecology training program. The strategy encompassed a virtual weeklong elective with the goals of bolstering their residency applications and showcasing our faculty and residency training.

Expected Versus Experienced Liveability for Amenity Migrants in Cairns, Australia: The Grass is not Always Greener in the Tropics

ABSTRACT This study explores Australian amenity migrants' experiences in Cairns, comparing expectations of a tropical paradise with lived realities. Using episodic narrative interviews and Importance-Performance Analysis of liveability indicators, it uncovers discrepancies between idealised imaginaries and actual experiences. Key concerns include housing, safety, jobs, living costs, and challenges in building community connections. The findings highlight the gap between the tropical paradise image attracting migrants and liveability challenges of a regional city. This mixed-methods approach offers a transferable tool for examining expectation-experience gaps in amenity destinations, providing insights for policymakers to address liveability issues and build communities that meet diverse residents' aspirations.

The Houses of Hellenistic–Roman Tel Dor: A Study of Domestic Social Practices and Economic Activities

The Houses of Hellenistic–Roman Tel Dor: A Study of Domestic Social Practices and Economic Activities

Understanding food insecurity in Los Angeles County during the COVID-19 pandemic and its aftermath: A qualitative interview study

The COVID-19 pandemic brought increases in food insecurity in Los Angeles (L.A.) County, defined as lacking household access to adequate food because of limited money or other resources. Here, we aimed to understand the lived experiences of food insecurity during the COVID-19 pandemic and its aftermath. In August–December 2022, we interviewed 30 residents of L.A. County who were participants in an ongoing internet panel and had reported experiencing food insecurity between April 2020 and July 2021. A stratified-sampling approach was used to recruit a diverse sample with and without government food assistance. We report five key findings, which underscore the stress and worry associated with the experience of food insecurity, and the coping strategies people implemented: (1) The pandemic prompted food insecurity as well as stressful shifts in eating behaviors compared to before the pandemic, with some eating much less food, some eating less nutritious food, and some eating much more due to being stuck at home; (2) Buying food became more effortful and financially challenging; (3) Government food assistance from the Supplemental Nutrition Assistance Program (SNAP) was important for reducing food insecurity, but was sometimes insufficient, inconsistent, and didn't cover all retailers or food items; (4) Interviewees had to rely on their social networks, food banks or pantries, churches, and schools to meet their food needs and cope with food insecurity, but some faced barriers in doing so; (5) For some, food insecurity was worse in late 2022, almost two years after the pandemic started. We conclude with implications for policymakers and practitioners, emphasizing the importance of meeting the needs of diverse residents and addressing food insecurity in the aftermath of the COVID-19 pandemic.

Evaluating a peer-to-peer health education program in Australian public housing communities during the COVID-19 pandemic

BackgroundThe cohealth Health Concierge program operated in Melbourne, Australia from July 2020 to 30 June 2022. It provided peer-to-peer support to culturally and linguistically diverse residents of high-rise public housing. During this time, the COVID-19 public health response changed frequently and included movement restriction, testing and vaccination. We conducted a mixed-methods evaluation to determine the Health Concierge program’s impact on residents’ engagement with health services and public health activities.MethodsThe evaluation, informed by a Project Reference Group, used the RE-AIM framework. We analysed data from 20,901 routinely collected forms describing interactions between Concierges and residents from August 2021 to May 2022. Additional evaluation-specific data were collected between March and May 2022 in four housing estates; we surveyed 301 residents and conducted 32 interviews with residents, Concierges and program stakeholders.ResultsConcierges promoted COVID-safe behaviours; linked residents with support, testing and vaccination services; and disseminated up-to-date information. Of the 20,901 recorded interactions, 8,872 (42%) included Concierges providing support around COVID-19 vaccination. Most surveyed residents (191/301, 63%) reported speaking with a Concierge in the previous six months. The self-reported two-dose COVID-19 vaccine uptake was 94% (283/301). Some residents described having meaningful, appreciated conversations with Concierges, and some described superficial interactions. While residents initially welcomed the program, many felt it failed to evolve. Poorly defined management and hiring criteria led to variable program implementation. A need for bicultural workers to continue linking residents with services was discussed.ConclusionsConcierges’ impact on residents may have contributed to high community uptake of COVID-19 testing and vaccination, and had benefits beyond the COVID-19 remit. We recommend the program be revised and continued to inform further preparedness planning and support service access generally. Program models such as this have potential to inform and reassure high-risk communities during a pandemic. In addition, such programs can help overcome vaccine hesitancy and promote protective health behaviours, regardless of whether a pandemic is currently occurring. Ensuring these programs remain responsive to the changing needs of end-users needs over time is imperative.

The (un)caring experienced by racialized and/or ethnoculturally diverse residents in supportive living: a qualitative study

BackgroundRacialized and/or ethnocultural minority older adults in supportive living settings may not have access to appropriate services and activities. Most supportive living facilities are mainstream (not specific to one group); however, culturally specific facilities are purpose-built to accommodate older adults from a particular group. Our objective was to describe the perspectives of diverse participants about access to culturally appropriate care, accessible services, and social and recreation activities in culturally specific and mainstream (non-specific) supportive living facilities.MethodsWe conducted semi-structured interviews with 21 people (11 staff, 8 family members, 2 residents) from 7 supportive living homes (2 culturally specific and 5 mainstream) in Alberta, Canada. We used a rapid qualitative inquiry approach to structure the data collection and analysis.ResultsStaff and family members described challenges in accessing culturally appropriate care in mainstream facilities. Family members expressed guilt and shame when their relative moved to supportive living, and they specifically described long waitlists for beds in culturally specific homes. Once in the facility, language barriers contributed to quality of care issues (e.g., delayed assessments) and challenges accessing recreation and social activities in both mainstream and culturally specific homes. Mainstream facilities often did not have appropriate food options and had limited supports for religious practices. Residents who had better English language proficiency had an easier transition to supportive living.ConclusionsRacialized and/or ethnoculturally diverse residents in mainstream supportive living facilities did not receive culturally appropriate care. Creating standalone facilities for every cultural group is not feasible; therefore, we must improve the care in mainstream facilities, including recruiting more diverse staff and integrating a wider range of recreation and religious services and food options.

Key mechanisms of a gender and socially inclusive community engagement and participatory design approach in the RISE program in Makassar, Indonesia and Suva, Fiji

Globally, more than one billion people live in urban informal settlements and experience suboptimal access to safe water, sanitation and hygiene (WASH). Participatory approaches are increasingly being promoted in WASH interventions, but the key elements of these approaches are not well-defined. The Revitalising Informal Settlements and their Environments (RISE) program launched in 2017 uses a participatory approach to co-design water-sensitive infrastructure with residents of 24 urban informal settlements in Makassar, Indonesia and Suva, Fiji. Our objective was to identify key mechanisms of a gender and socially inclusive participatory approach for engaging diverse people in RISE. We conducted and analysed semi-structured in-depth interviews (IDIs) with 49 RISE program staff; IDIs with 29 residents from RISE settlements in Indonesia and Fiji; and 6 focus group discussions (FGDs) with RISE residents in Fiji in 2020–2021, after participatory design activities were complete. Resident participants were purposively selected for representation of women and men; high and low participation in RISE; and different levels of disability/impairment. The question guides were informed by the Consolidated Framework for Implementation Research (CFIR), which defines 39 constructs (grouped into five domains) that describe an intervention. The IDI and FGD transcripts were analysed thematically with deductive codes based on the CFIR. For each of the five CFIR domains, the construct that was most relevant to mechanisms for the engagement of diverse people was used for the final analysis. The findings identified several key mechanisms for engaging diverse residents in programs like RISE. Four of these are recommended for future implementation and scale-ups of RISE and similar programs: engaging with residents at the household level (and potentially the individual level); incorporating flexibility and adaptability throughout the program; having a diverse team; and maintaining regular contact and positive rapport between the staff and participants.

Effect of online public domain representation in neurosurgical resident recruitment and decision-making

OBJECTIVE Over the past 20 years, female representation in neurosurgical residency programs has steadily increased. Still, the number of Black women and Black neurosurgical residents overall has remained stagnant. The authors aimed to understand the factors that led to this stagnation and how online public domain representation informs current and upcoming resident recruitment and decision-making. METHODS The authors performed a retrospective study using the following public domain sources: Doximity, neurosurgical residency program websites, and LinkedIn. The authors collected data from all neurosurgery residents who matriculated into a US neurosurgical residency program from 2015 to 2022. Variables, including name, race, gender, year of matriculation, medical school, and undergraduate institution, were recorded. RESULTS The authors analyzed resident data from 110/113 (97.3%) US neurological surgery residency programs. Of these programs, 106 (96.4%) matriculated and retained ≥ 1 female resident over the study period. There were 408 (22.6%) female neurosurgical residents, with 37 (33.6%) programs accounting for 57.8% of all female neurosurgical residents. For those states with a female resident, the lowest percentage of female residents by state was in Iowa (6.25%) and the highest was in New Hampshire (50%). Of all programs, 60 (54.5%) matriculated and retained ≥ 1 Black resident over the study period. There were 88 (4.9%) Black neurosurgical residents, with 19 (17.3%) programs accounting for 55.7% of all Black neurosurgical residents. For those states with a Black resident, the lowest percentage of Black residents by state was in Maryland (2.0%) and the highest was in Arkansas (23.1%). CONCLUSIONS Recruiting and retaining female and Black residents has increasingly become a focus of neurosurgical programs across the country. The authors’ data show that female and Black residents overwhelmingly choose to apply to and matriculate into programs that demonstrate a commitment to diversity via their online presence. Programs wishing to recruit more diverse residents should make efforts to relay their dedication to diversity, inclusion, and performance through their online presence.

Examining Diversity Recruitment Efforts in US-Based Physical Medicine and Rehabilitation Residencies: A Survey of Program Directors on Gender, Ethnic and Racial Diversity, and Implications for Recruitment Efforts.

As the population of the United States continues to grow and diversify, it is critical that the medical profession follows. This study aimed to evaluate aspects of the current landscape of diversity within physical medicine and rehabilitation by surveying program directors of US-based physical medicine and rehabilitation residencies. The secondary aim was to identify program characteristics that correlate with more diverse residency classes. An online, cross-sectional 17-question survey was distributed to program directors of all US-based physical medicine and rehabilitation residencies with known contact information (95/100), with a completed survey response rate of 53% (50/95). Race and ethnicity categories of the survey were based on those used by the US Census. The percentages of individuals identifying as women or those underrepresented in medicine in this survey were below those of the general US population, a trend also seen within the field of physical medicine and rehabilitation overall. Linear regression revealed no statistically significant association between the percentage of underrepresented in medicine residents and commonly used diversity recruitment initiatives. There was a significant association between the presence of a departmental role for diversity, equity and inclusion and the percentage of women residents (odds ratio, 1.13; P = 0.017). Continued research is required to identify additional strategies with demonstrated efficacy in recruiting diverse residency applicants.

Coping with Complexity in Water Management: Lessons from Palestine

In this article, I examine the role of applied anthropology in coping with common water management dilemmas and in facilitating more equitable water management. Field research and interviews with Palestinian residents and water managers between 2012–2020 illuminate deep disagreements about two commonly used management tools: full-cost recovery pricing reforms and supply expansion through emerging water technologies. This case demonstrates that not only are there limits to the transportability of solutions across societies, but even within a society and among seemingly similar stakeholders, fundamental disagreement exists about a place’s water priorities and proper interventions. How do we explain the multiplicity of ways in which people seemingly of the same social group approach a single water issue? The article demonstrates an anthropological approach to understanding water use that draws political ecology’s focus on power together with attention to the intersectionality of peoples’ relationships to water. This approach can help water managers acknowledge the political impacts of purportedly apolitical management approaches, and it provides the basis for a more robust incorporation of diverse residents’ priorities into water management decision making.

Inferring nonwork travel semantics and revealing the nonlinear relationships with the community built environment

The relationship between the built environment and nonwork travels reveals potential supply-demand status between urban functional facilities and diverse living travels, which provide critical indicative information for urban spatial structure optimization. Benefiting from the large-scale travel datasets, it would be possible to investigate deeper research by modeling the implied nonwork travel semantics (such as travel purposes). This study designs a framework to reveal the nonlinear relationships between the community built environment and the potential semantics of nonwork travel trajectories. First, we construct indicators to characterize the built environment of individuals’ living communities. Then, focusing on the definition of activity areas around drop-off points, latent Dirichlet allocation (LDA) is utilized to infer the implied semantics of nonwork travel. The random forest model is employed to quantify the relationships between the community built environment and nonwork travel with various semantics. The experimental results obtained with real-life datasets from Haikou, China uncover both compensatory nonwork travel derived from diverse facility accessibility and the contributions of housing attributes to travel semantic discrepancies. The findings provide scientific references for the optimization of urban spatial layouts of both functional facilities and residential communities to meet the living demands of diverse residents without long-distance intracity travel.

Implementing and evaluating a diversity, equity, and inclusion resident recruitment strategy.

A recruitment strategy was designed to increase the racial diversity of applicants to the postgraduate year 1 pharmacy program at University of Michigan Health, Michigan Medicine (MM). This article describes MM's diversity, equity, and inclusion (DEI) residency recruitment approach, from conceptualization through implementation, and includes an evaluation of its effectiveness. The report of the American Society of Health-System Pharmacists (ASHP) Task Force on Racial Diversity, Equity, and Inclusion, published in January 2021, provided a foundation for our recruitment approach. The approach consisted of establishing a residency DEI subcommittee, conducting outreach to under-represented students, and reducing bias in the process by amending the application screening rubric. The combination of these efforts resulted in a 5% increase in applicants from pharmacy schools with a high proportion of under-represented minority students. A diverse residency program benefits patients, trainees, and the larger healthcare organization. In addition, incorporating DEI into resident recruitment is required by the new ASHP Accreditation Standard for postgraduate pharmacy residency programs effective July 1, 2023. Evaluation of our recruitment efforts demonstrated targeted recruitment as an effective strategy to increase the diversity of a residency program's applicants. There may be additional barriers not addressed by our interventions to be further explored.

Video Interviews and Surgical Applicants’ Ability to Assess Fit to Residency Programs

IntroductionDue to the COVID-19 pandemic, the recruitment cycle for the 2021 Match was performed virtually. This Association for Surgical Education (ASE)-sponsored survey set out to study applicants’ ability to assess the factors contributing to fit through video interviews. MethodsAn IRB-approved, online, anonymous survey was distributed to surgical applicants at a single academic institution and through the ASE clerkship director distribution list between the rank order list certification deadline and Match Day. Applicants used 5-point Likert-type scales to rate factors for importance to fit and their ease of assessment through video interviewing. A variety of recruitment activities were also rated by applicants for their perceived helpfulness in assessment of fit. ResultsOne hundred and eighty-three applicants responded to the survey. The three most important factors for applicant fit were how much the program cared, how satisfied residents seem with their program, and how well residents get along. Resident rapport, diversity of the patient population, and quality of the facilities were hardest to assess through video interviews. In general, diversity-related factors were more important to female and non-White applicants, but not more difficult to assess. Interview day and resident-only virtual panels were the most helpful recruitment activities, while virtual campus tours, faculty-only panels, and a program's social media were the least helpful. ConclusionsThis study provides valuable insight into the limitations of virtual recruitment for surgical applicants’ perception of fit. These findings and the recommendations herein should be taken into consideration by residency program leadership to ensure successful recruitment of diverse residency classes.

"Hard-To-Reach" or Hardly Reaching? Critical Reflections on Engaging Diverse Residents From Low Socio-Economic Status Neighborhoods in Public Health Research.

HINTS AND KINKS Int J Public Health, 05 January 2023 https://doi.org/10.3389/ijph.2022.1605296

Impacts of disaster exposure on climate adaptation injustice across U.S. cities

Climate disasters have become more frequent, more extreme, and more often coincide in different places and among diverse residents. Characteristics of residents like races are often associated with differing levels of vulnerability to climate disasters. Developing adaptation strategies that provide just and equal protection to diverse population groups has become an urgent concern. Here, we examine the spatial and quantitative distribution of 3,466 adaptation actions reported over the past five years among 983 U.S. urban counties with different racial groups and socioeconomic statuses. Our findings reveal significant and growing disparities in climate adaptation among U.S. urban counties with overrepresented White, Black and Asian residents. We also find that the local level of disaster exposure plays an unignorable role in deriving racial disparities in adaptation actions. Disaster exposure, characterized by expected annual loss, has a stronger impact on adaptation policymaking in urban counties with high proportions of Asian or Black residents, compared to those with high proportions of White residents. With limited adaptation resources, focusing heavily on areas with high exposure to disaster damages might hinder adaptation actions to protect vulnerable individuals, households and communities and thus exacerbates racial disparities in climate adaptation and causes adaptation failure of racially minority groups. Our study provides novel empirical evidence for researchers and decision-makers on the evaluation of justice in climate adaptation. The co-present disparities between climate disaster exposure and adaptation actions can serve as an indicator of the societal need for adaptation actions to be equally developed and implemented.

Four Perspectives on a Sustainable Future in Nosara, Costa Rica

The town of Nosara on Costa Rica’s Nicoya peninsula is home to a vibrant community of diverse residents and is adjacent to an important turtle nesting site. However, tensions between lifelong residents, more recent transplants, visitors, and developers have increased as more of the world discovers this once-isolated haven. Climate change, income inequality, and alienation from a distant government apparatus have further complicated effective land-use planning and fractured social cohesion. Using a mixed-method approach of in-depth interviews (n = 67), Q methodology (n = 79), and public deliberation (n = 88), we explored residents’ priorities for the future of their town. The results indicate four different perspectives on Nosara’s future. Despite the tensions among those four perspectives, they show consensus on one overarching community issue: the need for a sustainable development plan. The case also shows how Q-methodology can assist scholars and practitioners who embrace participatory approaches to policy development and conflict resolution in the environmental arena.

Identifying Nursing Homes With Diverse Racial and Ethnic Resident Compositions: The Importance of Group Heterogeneity and Geographic Context.

Racial/ethnic composition of nursing home (NH) plays a particularly important role in NH quality. A key methodological issue is defining when an NH serves a low versus high proportion of racially/ethnically diverse residents. Using the Minimum Data Set from 2015 merged with Certification and Survey Provider Enhanced Reports, we calculated the racial/ethnic composition of U.S.-based NHs for Black or Hispanic residents specifically, and a general Black, Indigenous, and People of Color (BIPOC) grouping for long-stay residents. We examined different definitions of having a high racial/ethnic composition by varying percentile thresholds of composition, state-specific and national thresholds, and restricting composition to BIPOC residents as well as only Black and Hispanic residents. NHs with a high racial/ethnic composition have different facility characteristics than the average NH. Based on this, we make suggestions for how to identify NHs with diverse racial/ethnic resident compositions.