Background: In 2023, the Accreditation Council for Graduate Medical Education (ACGME) incorporated health equity principles into residency program requirements to promote diversity, equity, and inclusion (DEI) initiatives. However, limited data exists on how pediatric residency leaders perceive these initiatives, particularly in the present climate. This study aims to evaluate program leaders’ perceptions of effectiveness of DEI initiatives and identify barriers and suggestions for successful implementation in pediatric residency training.
Methods: We conducted an IRB approved national cross-sectional survey of leaders from all 218 pediatric residency programs accredited by the ACGME for the 2023-2024 academic year.Our anonymous, web-based survey included 17 multiple-choice items with additional dropdown and free-text responses to assess program demographics; perceptions of effectiveness based on resident feedback, knowledge gained, and patient impact; perceptions of barriers; and future suggestions. The survey underwent pilot testing through four cognitive interviews and three online sample tests. We identified program directors using institutional websites and individually emailed each a personalized survey link to be used by them or forwarded to the individual most familiar with their program DEI efforts, with a limit of one response per institution. The survey remained open from April-July 2025 with at least three reminder emails sent to maximize participation.We used a mixed-methods approach including simple statistics to analyze multiple choice responses and three reviewers independently coded free-text responses using inductive thematic analysis.
Results: Seventy-eight of 218 pediatric residency programs responded (36% response rate). Most respondents were female (77%), program directors (76%), over 45 years old (46%), and had prior DEI training (69%). Nearly all programs (95%) reported active DEI initiatives and educational sessions were both the most common (92%) and most effective (35%) DEI initiative. Thematic analysis identified five elements associated with perceived effectiveness: (1) sustainability and leadership support, (2) experiential learning through community engagement, (3) resident leadership and ownership, (4) integration of DEI content into the formal curriculum, and (5) mentorship (Table 1).Political climate was the most frequently cited barrier to implementing DEI initiatives (65%). In response to changes in federal directives, three themes were identified: (1) adjusting the scope of DEI efforts, (2) loss of programs and support, and (3) fear of repercussions (Table 2).Suggestions for improving DEI efforts emphasized unity, leadership, and multimodal education.
Conclusions: Despite substantial political barriers, pediatric residency programs continue to advance health equity training by shifting their focus on unity, strong leadership, and multimodal education that is sustained, integrated, and fosters experiential learning.
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