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Growing work highlights the importance of diversity, equity, and inclusion (DEI) initiatives in graduate medical education. Few studies have employed participatory research approaches to solicit trainee perspectives related to DEI. Our goal was to utilize group concept mapping (GCM), a mixed-methods participatory research approach, to describe resident perspectives on DEI within a large pediatric residency program. To organize and represent their perspectives on DEI, trainees completed brainstorming, sorting/rating, and interpretation activities in accordance with GCM methodology. Activities occurred via two synchronous discussion sessions (brainstorming and interpretation) and an electronic survey (sorting/rating). Items from the brainstorming session were sorted (i.e. grouped into categories by similarity) and rated (i.e. ranked on perceived importance and likelihood to change) by participants individually. Multidimensional scaling and hierarchical clustering were used to generate point maps, cluster maps, and go-zone illustrations for use in the interpretation session. We present data regarding participant characteristics and engagement, results from GCM activities, and action steps from this process. There were a total of 127 trainees in the residency program in 2021-2022. Participation varied across activities (brainstorming session: 21 participants; sorting/rating: 48 participants; interpretation session: 20 participants). A total of 64 unique items were generated from brainstorming. Five clusters emerged: 1) city factors, 2) institutional factors, 3) program representation, 4) program components, 5) non-DEI program perks. Program representation and program components clusters were rated as the most important and the most likely to be changed. Participants identified several action steps during the interpretation session which were shared with institutional leadership to direct programmatic reform. We demonstrate the utility of GCM, a structured and scalable participatory research method, to characterize trainee perceptions of DEI in graduate medical education.

Resitting, being offered a 'second chance' at an exam following failure to achieve a passing grade, is both common and stressful in medical school. There is a significant gap in the medical education literature around evidence-based support for resitting medical students. The study explores medical student experiences of resits through a peer-assisted learning programme (PAL) delivered to early years resitting medical students at Imperial College School of Medicine (ICSM) in 2021 and 2022. To the authors' knowledge, this is the first qualitative study analysing early years medical students' experiences of resitting exams. The authors performed an inductive thematic analysis of 22 semi-structured interviews with early years medical students who resat exams at ICSM in 2022. The authors identified three key themes and a cross-cutting theme: Theme 1. Self: students' individual and internal characteristics and experiences that influenced their journey of resitting exams. Subthemes included self-sufficiency and students' emotional approach to resitting; Theme 2. Others: resitting students' social networks. Subthemes explored students' relationships as part of the ICSM academic community, with near-peer role models and with their emotional support networks; Theme 3. Structures: organisational and structural factors that influence student experiences of resit exams. Subthemes included academic information, welfare, and socio-economic factors. Cross-cutting theme. Stigma: experienced a lack of open communication around resitting. The data emphasises the holistic nature of resitting, with students' self-image, their relationships with others, and the structural and institutional context all impacting on their experience, cross-cut with their experience of stigma through silence. The authors suggest that resitting is about more than academic ability: the broader context of resit stigma plays a key role in students' experiences of resits. PAL may be a useful tool to address resit stigma alongside institutional commitments to rethink medical school culture around academic failure.

Objectives: The Accreditation Council for Graduate Medical Education (ACGME) defined 6 core competencies (medical knowledge, patient care, practice-based learning and improvement, systems-based practice, interpersonal and communication skills, and professionalism) to be used as a framework for outcomes-based assessment. Concurrent to the development of specialty-specific competencies and milestones, the concept of entrustable professional activities (EPAs) were introduced. EPAs describe what a learner can do at each of the 5 levels of entrustment. There are four pediatric acute and urgent and urgent care (PAC) fellowships to date, however, no curricular consensus exists. This article seeks to develop a set of nationally agreed-upon PAC-specific EPAs to be used by emerging fellowships.

Methods: Multi-step iterative qualitative study using a web-based survey was used for EPA development and validity. A modified-Delphi panel, comprised of pediatric educators from multiple institutions, participated in four rounds to reach consensus (≥80%). EPAs were ranked using a 5 point-Likert scale, then from most important to least important in series, and finally individually as yes/no for each EPAs inclusion.

Results: Survey response rate was 83% (19/23). Six of the 7 EPAs were deemed on average to be high priority or essential. There was clear consensus on four EPAs and less agreement amongst the other three. Ultimately, 3 of the 7 EPAs reached consensus for inclusion, with agreement ranging from 84% to 100%.

Conclusion(s): PAC-specific EPAs focusing on clinical excellence, procedural competence, and high-quality care were all deemed essential components for PAC fellowships. Delineation of these EPAs will be critical to guide development of fellowship curricula.

International medical students (IMS; non-U.S. citizens/permanent residents) greatly enhance the diversity of U.S. medical schools and serve in areas of greatest healthcare needs. Despite 15% of the US population being foreign born, international students represent < 2% of US-MD matriculants. Factors that contribute to this underrepresentation of IMS remain unknown. In this study, we analyzed the accessibility, quality, and inclusivity of publicly available admissions and financial aid policies at all US-MD schools, with the goal of evaluating potential institutional and informational barriers faced by IMS. Institutional webpages and American Association of Medical College (AAMC) databases were searched from May-July 2023 to gather IMS-specific admissions and financial aid information from 153 accredited US-MD schools. Two-tailed t-test or chi-square analysis was used to examine differences. An inductive thematic approach was used to qualitatively categorize institutional webpage friendliness. While 45% (69/153) of U.S.-MD schools reported accepting IMS, only 18% (27/153) admitted students without restrictions (e.g., Canadians only, state/religious preference). Further, 38% (26/69) of the schools that accept IMS did not provide financial aid information, while nearly two-thirds of the remaining schools required proof of personal financial ability with no institutional/federal support. International students also entered schools with a higher average Medical College Admission Test (MCAT) score and Grade Point Average (GPA). In the national AAMC databases, 19 additional programs were listed as accepting IMS although the institutional webpages stated otherwise; the databases also lacked details on specific restrictions posed by the majority of institutions. Of all 153 webpages, only 14% were deemed 'international friendly.' Restrictive admissions and financial aid policies as well as the poor quality and access to information are major barriers that affect IMS. Strategies that aim to overcome these challenges can greatly help advance diversity, equity, and inclusion in medical education.

Background: Anti-racism curricula are increasingly being recognized as an integral component of medical education. To our knowledge, there has not yet been a publication exploring resident perspectives from multiple institutions and explicitly representing both underrepresented in medicine (UIM) and non-UIM perspectives.

Objective: To explore and compare UIM and non-UIM pediatric residents' perspectives on the content and qualities of meaningful anti-racism curricula.

Methods: We performed an IRB-approved multi-institutional, qualitative study that incorporated Sotto-Santiago et al's conceptual framework for anti-racism education. Between February and May 2021, we conducted focus groups of UIM and non-UIM pediatric residents at three large residency programs in the United States. We developed focus group guides using literature review, expert consensus, feedback from study team racial equity experts, and piloting. Focus groups were conducted virtually, audio-recorded, and transcribed verbatim. We employed thematic analysis to code transcripts, create categories, and develop themes until we reached thematic sufficiency. We completed member checking to ensure trustworthiness of themes.

Results: Forty residents participated (19 UIM and 21 non-UIM) in a total of six focus groups. We identified 7 themes, summarized as: 1) racism in medicine is pervasive, therefore (2) anti-racism education is critical to the development of competent physicians, and 3) education should extend to all healthcare providers. 4) Residents desired education focused on action-oriented strategies to advance anti-racism, 5) taught by those with both learned and lived experiences with racism, 6) in a psychologically safe space for UIM residents, and 7) with adequate time and financial resources for successful implementation and engagement.

Conclusion: Our multi-institutional study affirms the need for pediatric resident anti-racism education, promotes co-creation as a method to affect culture change, and provides practical strategies for curricular design and implementation.

Aspiring to become a physician is a natural expectation for applicants to medical school. However, choosing a career in medicine is a critical decision, especially in countries where high school students can apply to medical school without an undergraduate degree. Students may select a medical career for various reasons, including parental pressure and academic performance. The question of whether there are students who enroll in medical school without clear intentions of becoming doctors has not been extensively investigated in the literature. We conducted a retrospective study at a national university in Japan. Given the scarcity of research examining medical students who did not have a clear intention to become doctors at the time of admission, we created a survey. The questionnaire asked students whether they had clear intentions to become doctors upon enrollment, and those who responded affirmatively were defined as students with clear intentions to become doctors at admission and assigned to the first group. The second group was composed of students who entered medical school without clear intentions to become doctors. We then compared the differences in sociodemographic characteristics and career determinants between these groups using statistical methods, including Chi-square tests and logistic regression. The collection rate of the questionnaire was 76.2%. We found that 28.8% of students at a national medical school in Japan entered medical school without clear intentions of becoming doctors. For these students, 'parental expectations' and 'peer influence' were identified as significant career determinants. No sociodemographic characteristics showed significant associations with the ambiguity of students' intentions to pursue a medical career at admission. This study confirmed that some students enroll in medical school without clear intentions of becoming doctors. The background factors related to this type of student were parental expectations and the influence of peers on career choice.

Introduction: This study aims to enhance the confidence and operational safety of 5th-year medical students in the operating room (OR), addressing their corona pandemic gap in surgical training.

Methods: We augmented the surgical curriculum focusing on pre-, intra-, and post-operative skills, centered around a phantom operation as a pre-test-retest simulation. We measured confidence to assist in surgery on a 5-level Likert-scale and monitored surgical performance metrics (skin-to-skin time, blood loss, blood and volume transfusion, complications, fatal outcome). Half the cohort was explicitly video trained in hemostasis, while the other half in emergency communication. Factual knowledge gains were assessed with online questionnaires. The groups served as reciprocal controls, as confidence (communication group) and surgical performance (bleeding group) were compared.

Results: Initially, the pre-test performance of the 126 participants on the phantom operation was suboptimal, ranging from poor to mediocre. Notably, the retest outcomes demonstrated significant surgical performance improvements following the targeted lessons (e.g. blood loss pre-test 906 ± 468 mL, retest 292 ± 173 mL, p < 0.01, n = 35 teams), with the most pronounced enhancements observed in confidence and emergency communication skills (confidence pre-test 2.42 ± 0.52, retest 3.55 ± 0.64, p < 0.01, n = 35 teams). There is a strong tendency (p = 0.08) that the communication group (1.28 ± 0.53) had higher gains in confidence than the bleeding group (0.997 ± 0.4) with a moderate effect size (Cohen's D = 0.6). Students reported increased confidence in assisting in surgery compared to their initial self-assessments. These results show that the structured exposure to a pre-test-retest phantom operation substantially elevates students' capability to act safely and assertively in the OR.

Discussion: This approach appears to foster a justified increase in confidence and surgical performance, potentially elevating patient safety among students and residents in training.

When clinician-educators and medical education researchers use and discuss medical education research, they can advance innovation in medical education as well as improve its quality. To facilitate the use and discussions of medical education research, we created a prefatory visual representation of key medical education research topics and associated experts. We conducted one-on-one virtual interviews with medical education journal editorial board members to identify what they perceived as key medical education research topics as well as who they associated, as experts, with each of the identified topics. We used content analysis to create categories representing key topics and noted occurrences of named experts. Twenty-one editorial board members, representing nine of the top medical education journals, participated. From the data we created a figure entitled, Medical Education Research Library. The library includes 13 research topics, with assessment as the most prevalent. It also notes recognized experts, including van der Vleuten, ten Cate, and Norman. The key medical education research topics identified and included in the library align with what others have identified as trends in the literature. Selected topics, including workplace-based learning, equity, diversity, and inclusion, physician wellbeing and burnout, and social accountability, are emerging. Once transformed into an open educational resource, clinician-educators and medical education researchers can use and contribute to the functional library. Such continuous expansion will generate better awareness and recognition of diverse perspectives. The functional library will help to innovate and improve the quality of medical education through evidence-informed practices and scholarship.

India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.

Academics in medicine are frequently asked to serve on panels to discuss their clinical, research, education, administrative or personal expertise. While panel discussions are often the highlight of a conference or event, in the medical literature, there is very little published on how an individual can effectively prepare and present as an expert panelist. This paper offers guidelines that will enable academics to prepare, deliver, and engage in active dialogue during a panel discussion. Specific tactics include how to accept invitations to serve on a panel, conducting pre-panel conference meetings and background research, preparing concise opening statements and new insights, connecting with the audience, answering questions in a collaborative spirit, and debriefing after the panel. These guidelines will be valuable to any individual invited to serve on a panel discussion and will promote future panelists in engaging in constructive and fulfilling dialogue, with the ultimate goal of leaving the audience with a greater understanding of the topic of discourse.