266 - Advancing Pediatric Health Equity through Assessment: Development and Implementation of Structured Assessment Forms in Residency Training

Publication Number: 1252.266

Ariel Winn, Boston Children's Hospital, Concord, MA, United States; Alyssa A. Pradarelli, University of Michigan Medical School, Ann Arbor, MI, United States; Daniel Schumacher, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Meghan O'Connor, University of Utah, Salt Lake City, UT, United States; Joanna Lewis, Advocate Children's Hospital - Park Ridge, Glenview, IL, United States; Elisa Phillips, Stanford University School of Medicine, Palo Alto, CA, United States; Jennifer Di Rocco, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; David A. Turner, American Board of Pediatrics, Chapel Hill, NC, United States; Camila Mateo, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Promoting health equity is critical to improving child health outcomes, yet assessment of health equity in pediatric training remains limited. Not only does this absence signal that this area is not valued, it also limits trainees' opportunities to develop competency. Workplace-based assessment (WBA), real-time assessment during authentic clinical encounters, offers an opportunity to capture and provide feedback on equity-promoting behaviors. To support this approach, the American Board of Pediatrics funded development of a mobile application for pediatric residency programs that uses brief ( < 3-minute) forms completed shortly after patient encounters, with two types of forms: 1. "Activity-based" forms tied to specific clinical encounters (e.g., acute care visit) that include activity selection, supervision scale, and space for narrative comments, and 2. "Narrative" forms that capture topic-based observations through free text alone.

Objective: To describe the design, implementation, and utilization patterns of health equity assessment forms across pediatric residency programs.

Design/Methods: A "Narrative" health equity assessment form was developed and deployed to 15 sites in a phased approach beginning September 2024 (Figure 1). Following analysis demonstrating underutilization, a redesign process with iterative expert feedback led to the development of an "Activity-based" form launched in July 2025 (Figure 2), corresponding to the implementation at an additional 65 programs. Both forms remained available to users.

We compared health equity utilization rates to other assessments before and after Activity-based form implementation and examined utilization patterns between the two forms.

Results: When only the Narrative form was available (September 2024-June 2025; 15 sites), health equity assessments represented 3.57% of all narrative assessments (20% expected if equally distributed) and 0.8% of total assessments. After introducing the Activity-based form (July-October 2025; 80 sites), utilization shifted toward this format (144 vs 59 Narrative assessments), though it remained underrepresented at 0.8% of Activity-based assessments (8.3% expected if equally distributed). Combined health equity assessment rates remained at 0.8% of all assessments.

Conclusion(s): While any attention to health equity assessment represents progress, it remained underrepresented in this WBA pilot, warranting further attention. Future work includes qualitative analysis of collected data, investigation of facilitators and barriers to use, and examination of how feedback promotes learning and culture change around health equity.

Figure 1: Narrative-Only Health Equity Assessment Form
Image 11-3-25 at 10.30 PM.jpegForm content and key design decisions for the initial narrative-based approach to health equity assessment (September 2024)

Figure 2: Activity-Based Health Equity Assessment Form
Image 11-3-25 at 10.31 PM.jpegForm content and key design decisions for the EPA-based approach to health equity assessment (July 2025)