S2967 Evolution of Diversity and Representation of Minoritized Individuals in Educational Questions in Gastroenterology in 2025

Introduction: In the wake of racial reckoning in the USA in 2020 and the attacks on diversity, equity, and inclusion (DEI) initiatives in 2025, the health disparities of minoritized individuals is back to the center of discussion in medical education. We aimed to assess the evolution of representation in graduate medical education in gastroenterology/hepatology by investigating the extent to which there is diverse representation in clinical cases in 3 large question banks published by major scientific GI societies in 2022 and 2025. Methods: We reviewed 2 cohort of questions in the years 2022 and 2025: the DDSEP+ and DDSEP10 question bank from American Gastroenterological Association, the 2022 and 2024 self-assessment test from American College of Gastroenterolgy and Gastrointestinal Endoscopy Self-Assessment Product from American Society for Gastrointestinal Endoscopy offered for ABIM GI certification exam preparation. We only included questions pertaining to clinical cases in our analysis. We collected data on age, and socio-demographics (SD) such as gender identity, race, nationality physical and mental ability, job status, educational level, immigration status, sexual orientation, and marital or dating status. Results: We reviewed a total of 2,934 clinical questions (1,544 questions in 2022 and 1,390 questions in 2025). Median age was similar in both years around 48 years and ranged from 2 days to 98 years. 48.8% (n = 753) were identified as women with she/her pronouns in 2022, with 50.1% (n = 694) in 2025. Around 1% of each cohort carried no gender identification, while only 1 patient was transgender in the 2025 cohort. 11.1% (N = 171) cases included a description of any SD factors in 2022, while the number slightly increased to 13.1% (N = 182) in 2025. In these instances, the correct answer was more likely to be associated with these factors, whenever mentioned in the question stem, compared to questions that did not specify any SD. The RR was 1.87 [95% CI = 1.52–2.30]) in 2022, increasing to RR = 2.09 [95% CI = 1.69-2.59] in 2025. Conclusion: Despite AAMC DEI competency guidelines, GI board review questions continue to lack diverse patient representation. Failing to include diverse SD in clinical cases creates a non-authentic perception of our society and contributes to the lack of representation in medicine. Stereotyping becomes more striking when the correct answer is usually associated with any of the rare instances a SD factor is mentioned in the stem of the question. This stereotyping is currently more pronounced in 2025, with concerning implications especially when it is coupled with a harsh political climate for DEI initiatives nationwide.