In recent years, there has been a rising and intensifying discourse around the impact of DEI in Medicine, particularly in medical student and resident training. With the diverse patient population makeup, there is an increased need for minority physicians and healthcare professionals with whom these patients can identify and better relate to. Many institutions and programs have recognized this need and have actively implemented strategies that promote DEI awareness among their medical students and residency trainees. The effectiveness of these programs, however, is not clearly known. There is a difference between implementing actionable targets in training programs that actually help foster growth and advancement of DEI efforts, and simply implementing activities that do not have much impact. Our study sought to examine opinions and perspectives on DEI events used during medical training and the impact of this DEI training on patient care.
Our results suggest that medical trainees recognize the importance of DEI events in their various institutions and their impact on their awareness of patient diversity, and inequities affecting patient care. On the other hand, interest in DEI events on the residency interview trail and beyond medical school seems to be diminished. While our data suggests that medical students feel DEI events may be beneficial to their training, more efforts are needed to increase the impact of DEI events on residency interviews, subsequent admission into residency programs. There are several reasons this might be the case. In our research, we postulate that one area to investigate is the opinions and perspectives of medical students and residents on DEI-based curriculum, and the value they assign to it. Programs can implement seminars and lectures and extracurricular DEI activities, but if trainees are not actively engaged in these discussions, or do not find them particularly stimulating, the impact or intended results may not be felt by these students. Furthermore, if these events are being attended by students only, but not by training program faculty, staff, and administrators, trainees may view this as a “bare minimum” effort by the programs to check off the boxes necessary for them to claim investment in DEI efforts [17].
Despite the many hours of implicit bias, cultural awareness and DEI training completed in medical school, residency programs and within hospital systems, examples of blatant disregard for minority patient interests and minority physician opinions still arise. For example, Grubbs (2023) reports of a case where a physician was terminated from their employment after they facilitated a discussion on race and gender health bias with medical students [18]. When the physician in question filed a lawsuit challenging their dismissal, the U.S. National Labor Relations Board (NLRB) office of General Counsel supported her lawsuit by filing an additional lawsuit against the institution, in which they concurred that under the National labor Relations Act (NLRA), her facilitation of a DEI discussion was protected under Section 7 of the ACT (NLRA; 29 U.S.C. §§ 151–169) [19]. Incidents such as these highlight the necessity for more measures to be taken to ensure that medical trainees, minority or otherwise, are not only equipped with the tools to ensure proper care of diverse patients, but also the space to discuss their own encounters with racism, sexism, and other disparities without fear of retaliation, reprisal, or pushback.
We reckon from this study that successful implementation of DEI training of medical students and residency trainees requires their direct involvement in planning of DEI activities used in the curriculum. It is important that medical students be encouraged to speak up and identify events with potential to enhance their understanding of the U.S. patient population diversity and complexity. Furthermore, our study shows a need to continue DEI education during residency training. It is likely that due to challenges involving the rigor of residency training most residency programs will prioritize other aspects of their training over DEI activities. Our study, however, suggests that further training in DEI may still have long-term benefits for both the trainees and the institutions.
Overall, our results suggest that successful implementation of DEI programs in the medical curriculum requires direct input from participating students. It is particularly important to seek opinions and perspectives of medical students and residents on the nature of DEI events to be incorporated into their training.
Limitations:
Our study had several limitations. These included a small sample size of 130. We also had limited responses from residency trainees (n = 10). This was attributed to residents’ busy schedules and our limited methods of survey distribution. Due to these limitations, this data should be extrapolated with caution. While a broader national study on these topics is required with a larger population size, results from our study validate findings from previous studies showing the importance of getting student perspectives when designing medical curricula.