Trainee perspectives on diversity, equity, and inclusion: a group concept mapping study

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.