P3.O283: A Transformative Approach to Holistic Application Review Focused on Equity, Diversity, and Inclusion Efforts in a Pediatric Subspecialty Fellowship

Background: Workforce parity that mirrors the diversity of patient populations is a crucial step in addressing healthcare disparities in order to provide high-quality, culturally competent care for pediatric patients. We share insights into the challenges, initiatives, and strategies aimed at enhancing holistic fellowship recruitment efforts at our tertiary care, university-based pediatric emergency medicine (PEM) fellowship with a corresponding free-standing children’s hospital; with the hope of extrapolating this work to other pediatric subspecialties to train a more diverse next generation of specialized pediatricians.

Methods: We utilized a mixed methods approach of qualitative interviews, survey feedback, and implementation science. Opportunities for improvement within equity, diversity, and inclusion (EDI) were identified via an internal self-review. Support was granted from divisional, departmental, hospital, and graduate medical education leadership. Leadership from six graduate medical education training programs were interviewed and shared areas to target including application review, cultivating an inclusive environment, strategic outreach/recruitment, diversity training for selection committee, and evaluation/continuous improvement (Figure 1).

Results: Changes were iteratively implemented starting in the 2021 application season, with an overall increase in the percentage of non majority applicants with efforts positively received by applicants and faculty (Table 1). In the 2021 season, one non-majority ethnicity fellow matched at our institution, and three who identify as women. In the 2022 season, three non-majority ethnicity fellows matched at our institution, one who identified as a woman, and one with a work visa who had graduated from an international medical school. In the 2023 season, we matched two non-majority ethnicity fellows, two who identify as women, one from an emergency medicine residency trained background (only one other in the history of the fellowship since its inception in 1988), one who completed medical school at an international medical school, and the first fellow to hold an osteopathic medical degree.

Conclusion: We were able to impact the number of non-majority applicants interviewed and matched to our fellowship via holistic recruitment strategies to improve not only visible diversity, but also non visible diversity attributes that have historically been biased against. We hope to disseminate these efforts to other pediatric subspecialties to create a more inclusive environment for not only trainees, but also for patients. Future directions include continuous process improvement and how to impact diverse trainees to diverse faculty recruitment and retention.