258 - Pediatric Residency Program Leaders’ Perspective on the Effectiveness, Challenges, and Future Directions of Health Equity Initiatives

Publication Number: 1244.258

Heriberto Martinez, Phoenix Children's Hospital, Scottsdale, AZ, United States; Jared Kusma, Phoenix Children's, Phoenix, AZ, United States; Alisa Khan, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Kristen Samaddar, Phoenix Children's Hospital, Phoenix, AZ, United States; Sandra Gage, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States; Nehal Thakkar, Phoenix Children's Hospital, Phoenix, AZ, United States

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. Limited data exists on how pediatric residency leaders perceive the effectiveness of these initiatives and barriers that hinder their implementation, particularly in the present climate.

Objective: Evaluate program leaders' perceptions of effectiveness of DEI initiatives and identify barriers and suggestions for implementation in pediatric residency training.

Design/Methods: We conducted a national cross-sectional survey of leaders from all 218 pediatric residency ACGME accredited programs for 2023/2024.

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 was pilot tested via 4 cognitive interviews and 3 online sample tests. We identified program directors using institutional websites and emailed each a survey link to be used by them or forwarded to the individual most familiar with their program DEI efforts, with one response per institution. The survey was open from April-July 2025 with at least 3 reminder emails sent.

We used simple statistics to analyze multiple choice responses and 3 reviewers coded free-text responses using inductive thematic analysis.

Results: 78 of 218 pediatric residency programs responded (36%) (Table 1). Educational sessions were both the most common (92%) and most effective (35%) DEI initiative. Thematic analysis identified 5 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 2).

Political climate was the most frequently cited barrier to implementing DEI initiatives (65%). Themes resulting from shifts in federal directives included: (1) adjusting scope of DEI efforts, (2) loss of programs and support, and (3) fear of repercussions (Table 3).

Suggestions for improving DEI efforts emphasized unity, leadership, and multimodal education.

Conclusion(s): 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.

Table 1. Program and Participant Characteristics


Table 2. Thematic Analysis of What Makes DEI Initiatives Effective in Pediatric Residency Programs


Table 3. Thematic Analysis of Institutional Shifts in DEI Efforts Related to Federal Directives and Suggestions for Improvement