Search

Nursing education research about inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health content in undergraduate nursing curricula primarily focuses on student learning outcomes. There is less research evidence about the experiences of nursing faculty with teaching LGBTQ+ health topics. The purpose of this scoping review was to identify current evidence about pre-licensure, undergraduate nursing faculty knowledge, beliefs, and experiences with teaching LGBTQ+ content. Six EBSCO databases were searched for manuscripts published between 2012 and 2023. Peer-reviewed articles, published in English, describing studies of pre-licensure, undergraduate nursing faculty knowledge, beliefs, and experiences with teaching LGBTQ+ health content were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was used to guide inclusion of studies for review. The literature search yielded 612 results, of which 58 were selected for full text screening. Twelve total studies were retained for this scoping review. Faculty knowledge related to LGBTQ+ health is framed by a "deficit narrative," emphasizing physical and mental health risks and negative outcomes. Faculty beliefs are often measured with instruments that reflect cisnormativity or heteronormativity. There is an ongoing need to research the experiences of inclusion of LGBTQ+ content by pre-licensure, undergraduate nursing faculty. • Nursing faculty exhibit knowledge about LGBTQ+ populations reflecting a "deficit model of difference," emphasizing risk and negative outcomes • Research on nursing faculty beliefs about LGBTQ+ populations that center negative biases can inadvertently reinforce those biases • More research needs to be conducted to understand nursing faculty experiences with including LGBTQ+ health content in teaching [ABSTRACT FROM AUTHOR]

Abstract Background Policy research aims to provide evidence to inform government policy decisions about health and social care. Engaging and involving the public and patients in this work is widely recognised as essential. Research funders prioritise equality, diversity and inclusion (EDI) in patient and public involvement and engagement (PPIE), but people who are most likely to experience poor outcomes are also those least likely to be involved in research. This paper describes our experience of setting out to understand how to overcome barriers to EDI in PPIE in the research carried out by the National Institute for Health and Care Research (NIHR) Policy Research Unit in Maternal and Neonatal Health and Care (PRU-MNHC), in a PPIE consultation project we called The Listening Series. Methods We convened five video-recorded online discussion groups involving 20 individuals advocating for groups who are under-represented in our research. Those taking part included people working with Black and Asian women and families, young parents, those from socially deprived backgrounds, and women and families with physical and learning disabilities. Discussions focussed on practical solutions to addressing challenges to people being excluded, and how to improve EDI in our research. Learning and reflection Five key themes were identified: ‘build trust’; ‘involve us from the beginning’; ‘show us impact’; ‘use clear, appropriate and inclusive communication’; and ‘imagine life in our shoes’. We used the learning to create a guidance document for researchers and an accompanying 15-minute film. We also took practical steps to embed the learning strategically by expanding our Task Group for PPIE in the PRU-MNHC to include four Listening Series invitees with a remit to champion EDI in our research and ensure that it is embedded in our PPIE activities. We continue to reflect on and work to address the associated challenges. Conclusions The Listening Series helped us rethink our processes for inclusion to go beyond traditional methods of involvement and engagement. The themes identified pose challenges that require time, resource and empathic engagement from researchers to be meaningfully resolved. This has implications for policy makers and research funders who need to consider this in their processes.

Background: Policy research aims to provide evidence to inform government policy decisions about health and social care. Engaging and involving the public and patients in this work is widely recognised as essential. Research funders prioritise equality, diversity and inclusion (EDI) in patient and public involvement and engagement (PPIE), but people who are most likely to experience poor outcomes are also those least likely to be involved in research. This paper describes our experience of setting out to understand how to overcome barriers to EDI in PPIE in the research carried out by the National Institute for Health and Care Research (NIHR) Policy Research Unit in Maternal and Neonatal Health and Care (PRU-MNHC), in a PPIE consultation project we called The Listening Series. Methods: We convened five video-recorded online discussion groups involving 20 individuals advocating for groups who are under-represented in our research. Those taking part included people working with Black and Asian women and families, young parents, those from socially deprived backgrounds, and women and families with physical and learning disabilities. Discussions focussed on practical solutions to addressing challenges to people being excluded, and how to improve EDI in our research. Learning and reflection: Five key themes were identified: 'build trust'; 'involve us from the beginning'; 'show us impact'; 'use clear, appropriate and inclusive communication'; and 'imagine life in our shoes'. We used the learning to create a guidance document for researchers and an accompanying 15-minute film. We also took practical steps to embed the learning strategically by expanding our Task Group for PPIE in the PRU-MNHC to include four Listening Series invitees with a remit to champion EDI in our research and ensure that it is embedded in our PPIE activities. We continue to reflect on and work to address the associated challenges. Conclusions: The Listening Series helped us rethink our processes for inclusion to go beyond traditional methods of involvement and engagement. The themes identified pose challenges that require time, resource and empathic engagement from researchers to be meaningfully resolved. This has implications for policy makers and research funders who need to consider this in their processes. Plain English Summary: What we know: It is important that health care researchers involve patients and the public from a wide range of social and ethnic backgrounds in research, but we know that this often does not happen. We are a group of researchers and patient/public representatives, working in research to improve care for pregnant women and babies. We wanted to find out how to involve people from more diverse backgrounds in our research. What we did: We organised five online discussion groups with 20 people working with Black and Asian families, young parents, those from socially deprived backgrounds and parents with physical or learning disabilities. We asked them what we should do to involve a wider range of people in our research. We called this The Listening Series. We summarised the most important things people said in a written guide for researchers and a short film. We then asked people who had been invited to take part in The Listening Series to join us to develop new ways of working together. What we learned: The five themes we identified were: 'build trust'; 'involve us from the beginning'; 'show us impact'; 'use clear, appropriate and inclusive communication'; and 'imagine life in our shoes'. In summary, researchers need to take the time to build trusting relationships with patients and the public; actively listening and learning from them. This can be challenging for researchers and patient representatives. Research funders need to allow time and money for this to happen in a meaningful way. [ABSTRACT FROM AUTHOR]

As a field of study, ethnobotany is known for its interdisciplinary nature, drawing from a range of subjects, such as botany, anthropology, chemistry, ecology, and others. Though ethnobotany is broad and diverse, it does—on occasion—fall short when examining specific theoretical orientations and their applications within the discipline. In addition to this, there are many other forms of theoretical orientation—especially from the social sciences—that may hold great value for ethnobotany; some of these hold extra promise as a result of their inherent connection to themes of Diversity, Equity, and Inclusion (DEI) that have become increasingly acknowledged for their importance in academia in recent years. One such theoretical orientation is queer theory. The following paper provides a brief historical and epistemological overview of queer theory, and proposes a need for the development and practice of queer ethnobotany. Not only does queer theory stand to make ethnobotany a more diverse and accepting field, but it also has the potential to contribute to expanding upon the theoretical toolkit ethnobotanists may draw on in the classroom, the field, and beyond. [ABSTRACT FROM AUTHOR]

Background: A shortage of images of pathology on diverse skin tones has been recognized for decades in health professions education. Identifying skin manifestations of disease depends on pattern recognition, which is difficult without visual examples. Lack of familiarity with visual diagnosis on skin of color can lead to delayed or missed diagnoses with increased morbidity and mortality. As the United States continues to increase in ethnic and racial diversity, addressing the disparity in health outcomes with education is vital. Case Presentation: At the Hackensack Meridian School of Medicine, students, librarians, and faculty came together to address this problem and develop a database of dermatological conditions in people with darker skin tones. A student group initiated a series of meetings with faculty to determine the best approach to address and enhance the representation of diversity in disease images within the curriculum. With the guidance of faculty and librarians, students performed a literature search and created a database of images of skin pathologies in people with darker skin tones. The database was disseminated to course directors and lecturers, and the noted disparities were corrected for the next cohort of students. The database provides an easily accessible resource for creating lecture slides. Conclusion: This project brought awareness of the need for inclusivity and generated a broad review of the curriculum to be more representative of all patient populations. Most importantly, our experience provides a roadmap for institutional change through student, librarian and faculty collaboration and cultivation of a culture of optimism and acceptance.

Background: Certain populations have been historically underrepresented in clinical trials. Broadening eligibility criteria is one approach to inclusive clinical research and achieving enrollment goals. How broadened trial eligibility criteria affect the diversity of eligible participants is unknown. Methods: Using a nationwide electronic health record-derived deidentified database, we identified a retrospective cohort of patients diagnosed with 22 cancer types between April 1, 2013 and December 31, 2022 who received systemic therapy (N=235,234) for cancer. We evaluated strict versus broadened eligibility criteria using performance status and liver, kidney, and hematologic function around first line of therapy. We performed logistic regression to estimate odds ratios for exclusion by strict criteria and their association with measures of patient diversity, including sex, age, race or ethnicity, and area-level socioeconomic status (SES); estimated the impact of broadening criteria on the number and distribution of eligible patients; and performed Cox regression to estimate hazard ratios for real-world overall survival (rwOS) comparing patients meeting strict versus broadened criteria. Results: When applying common strict cutoffs for eligibility criteria to patients with complete data and weighting each cancer type equally, 48% of patients were eligible for clinical trials. Female (odds ratio, 1.30; 95% confidence interval [CI], 1.25 to 1.35), older (age 75+ vs. 18 to 49-years old: odds ratio, 3.04; 95% CI, 2.85 to 3.24), Latinx (odds ratio, 1.46; 95% CI, 1.39 to 1.54), non-Latinx Black (odds ratio, 1.11; 95% CI, 1.06 to 1.16), and lower-SES patients were more likely to be excluded using strict eligibility criteria. Broadening criteria increased the number of eligible patients by 78%, with the strongest impact for older, female, non-Latinx Black, and lower-SES patients. Patients who met only broadened criteria had worse rwOS versus those with strict criteria (hazard ratio, 1.31; 95% CI, 1.27 to 1.34). Conclusions: Data-driven evaluation of clinical trial eligibility criteria may optimize the eligibility of certain historically underrepresented groups and promote access to more inclusive trials. (Sponsored by Flatiron Health.) [ABSTRACT FROM AUTHOR]

Background: Administration of anti-CD19 chimeric antigen receptor T-cell (CART19) immunotherapy for large B-cell lymphomas (LBCLs), a subset of non-Hodgkin lymphoma (NHL), involves high costs and access to specialized tertiary care centers. We investigated whether minority health populations (MHPs) have equal access to CART19 and whether their outcomes are similar to those of non-MHPs. Methods: We analyzed the prevalence and clinical outcomes of patients treated with commercial CART19 at two geographically and socioeconomically different institutions: the Abramson Cancer Center (ACC, Philadelphia, Pennsylvania) and the Knight Cancer Institute (KCI, Portland, Oregon). Results: In the ACC catchment area, 8956 patients were diagnosed with NHL between 2015 and 2019 (latest available data from the state registry), including 17.9% MHPs. In the ACC, between 2018 and 2022 (CART became available in 2018), 1492 patients with LBCL were treated, and 194 received CART19. The proportion of MHPs was 15.7% for the entire LBCL cohort but only 6.7% for the CART19 cohort. During the same time, in the KCI catchment area, 4568 patients were diagnosed with NHL, including 4.2% MHPs. In the KCI, 396 patients with LBCL were treated, and 47 received CART19. The proportion of MHPs was 6.6% for the entire LBCL cohort and 4.2% for the CART19 cohort. The 3-month response, survival, and toxicities after CART19 infusion showed similar results, although the number of patients who were treated was limited. Conclusions: This study shows that the access of MHPs to tertiary centers for LBCL care was preserved but appeared reduced for commercial CART19 immunotherapy. Although clinical outcomes of MHPs seemed similar to those of non-MHPs, the small sample size precludes drawing firm conclusions. Further studies are needed. (Funded by the Laffey McHugh Foundation and others.) [ABSTRACT FROM AUTHOR]

Equity, diversity, and inclusion (EDI) are essential for healthcare organizations since they allow for the development of programs and initiatives that bring together diverse perspectives and knowledge. Global multidisciplinary organizations, such as the Multinational Association for Supportive Care in Cancer (MASCC), need to understand the perspective of their members regarding EDI to identify opportunities to enhance diversity and inclusiveness and to better meet the needs of members from different backgrounds and resources. The MASCC Health Disparities Committee designed a survey to identify issues related to disparities faced by MASCC members when providing supportive care to patients with cancer and to examine the EDI landscape within the organization. Here, we report results related to EDI initiatives within the organization. Two-hundred and eighteen MASCC members responded to the survey (response rate 10.2%). The results indicated that respondents were generally satisfied with how MASCC manages leadership, membership, and organization-related EDI issues. Opportunities for improvement noted by respondents included developing strategies to foster a more diverse membership, improving communication regarding diversity in the organization, and increasing EDI content in educational sessions and publications. The results of this survey represent the first attempt at understanding how to improve EDI within MASCC and will be utilized to guide further initiatives and programs. [ABSTRACT FROM AUTHOR]

• The antiracism approach seeks out and addresses harmful policies, procedures, and practices. • Future APRNs should be prepared to address embedded structural inequalities. • Implementing an antiracism framework in pediatric nurse practitioner programs and all NP programs. Poor health outcomes for children are directly tied to poor social determinants of health and systemic, embedded health care inequities. To prepare the next generation of pediatric advanced practice registered nurses (APRNs), nursing schools must educate students to address inequities through innovative curricular models and teaching modalities. The purpose of this manuscript is to describe the application of an antiracism framework to a graduate APRN program. This article describes the application of this framework, which led to significant administrative, curricular, and course changes to prepare pediatric-focused APRN students to address the health inequities and poor social determinants of health facing children today. By describing our journey to embed an antiracism framework, other nursing schools can make substantive changes necessary to prepare their students to address these health inequities. [ABSTRACT FROM AUTHOR]

Campuses are experimenting with new ways to structure and organize diversity, equity, and inclusion (DEI) work. Existing organizational structures tend to focus either on top-down or vertical ways of organizing DEI work (e.g. chief diversity officer positions) or more horizontally integrated designs such as DEI committees. These structures are limited in their ability to embed the type of culture change necessary to erode entrenched inequities on college and university campuses. Our study identifies organizational structures that are more shared or matrix-like as promising approaches for transforming campus culture. We specifically describe four different models of a more shared organizational design for DEI and discuss the implications of changing structures in this way. [ABSTRACT FROM AUTHOR]

Summary: Clinical trial participation across disease areas, including Alzheimer's disease (AD), has been biased towards White participants of European ancestry. To support clinical decision-making across diverse populations, we must recognize and address barriers to trial participation. To inform the design of ALUMNI AD, a trial focused on historically underrepresented AD populations, we held advice-seeking fora with key stakeholders to understand barriers and identify potential solutions to maximize trial participation of underrepresented racial and ethnic groups in the US. Strategies identified from this process include: obtaining and implementing recommendations from community stakeholders; establishing a simple and inclusive prescreening and screening process; supporting participants and care partners; identifying and activating community-centric clinical sites; and demonstrating community commitment. While ALUMNI AD did not commence, we hope that our insights could be incorporated into future studies to improve diversity, equity, and inclusion in AD clinical research. Funding: This study was sponsored by Genentech, Inc.

Background: Practitioner and family experiences of pediatric re/habilitation can be inequitable. The Young Children's Participation and Environment Measure (YC-PEM) is an evidence-based and promising electronic patient-reported outcome measure that was designed with and for caregivers for research and practice. This study examined historically minoritized caregivers' responses to revised YC-PEM content modifications and their perspectives on core intelligent virtual agent functionality needed to improve its reach for equitable service design. Methods: Caregivers were recruited during a routine early intervention (EI) service visit and met five inclusion criteria: (1) were 18 + years old; (2) identified as the parent or legal guardian of a child 0–3 years old enrolled in EI services for 3 + months; (3) read, wrote, and spoke English; (4) had Internet and telephone access; and (5) identified as a parent or legal guardian of a Black, non-Hispanic child or as publicly insured. Three rounds of semi-structured cognitive interviews (55–90 min each) used videoconferencing to gather caregiver feedback on their responses to select content modifications while completing YC-PEM, and their ideas for core intelligent virtual agent functionality. Interviews were transcribed verbatim, cross-checked for accuracy, and deductively and inductively content analyzed by multiple staff in three rounds. Results: Eight Black, non-Hispanic caregivers from a single urban EI catchment and with diverse income levels (Mdn = $15,001–20,000) were enrolled, with children (M = 21.2 months, SD = 7.73) enrolled in EI. Caregivers proposed three ways to improve comprehension (clarify item wording, remove or simplify terms, add item examples). Environmental item edits prompted caregivers to share how they relate and respond to experiences with interpersonal and institutional discrimination impacting participation. Caregivers characterized three core functions of a virtual agent to strengthen YC-PEM navigation (read question aloud, visual and verbal prompts, more examples and/or definitions). Conclusions: Results indicate four ways that YC-PEM content will be modified to strengthen how providers screen for unmet participation needs and determinants to design pediatric re/habilitation services that are responsive to family priorities. Results also motivate the need for user-centered design of an intelligent virtual agent to strengthen user navigation, prior to undertaking a community-based pragmatic trial of its implementation for equitable practice. [ABSTRACT FROM AUTHOR]

Abstract Background Practitioner and family experiences of pediatric re/habilitation can be inequitable. The Young Children’s Participation and Environment Measure (YC-PEM) is an evidence-based and promising electronic patient-reported outcome measure that was designed with and for caregivers for research and practice. This study examined historically minoritized caregivers’ responses to revised YC-PEM content modifications and their perspectives on core intelligent virtual agent functionality needed to improve its reach for equitable service design. Methods Caregivers were recruited during a routine early intervention (EI) service visit and met five inclusion criteria: (1) were 18 + years old; (2) identified as the parent or legal guardian of a child 0–3 years old enrolled in EI services for 3 + months; (3) read, wrote, and spoke English; (4) had Internet and telephone access; and (5) identified as a parent or legal guardian of a Black, non-Hispanic child or as publicly insured. Three rounds of semi-structured cognitive interviews (55–90 min each) used videoconferencing to gather caregiver feedback on their responses to select content modifications while completing YC-PEM, and their ideas for core intelligent virtual agent functionality. Interviews were transcribed verbatim, cross-checked for accuracy, and deductively and inductively content analyzed by multiple staff in three rounds. Results Eight Black, non-Hispanic caregivers from a single urban EI catchment and with diverse income levels (Mdn = $15,001–20,000) were enrolled, with children (M = 21.2 months, SD = 7.73) enrolled in EI. Caregivers proposed three ways to improve comprehension (clarify item wording, remove or simplify terms, add item examples). Environmental item edits prompted caregivers to share how they relate and respond to experiences with interpersonal and institutional discrimination impacting participation. Caregivers characterized three core functions of a virtual agent to strengthen YC-PEM navigation (read question aloud, visual and verbal prompts, more examples and/or definitions). Conclusions Results indicate four ways that YC-PEM content will be modified to strengthen how providers screen for unmet participation needs and determinants to design pediatric re/habilitation services that are responsive to family priorities. Results also motivate the need for user-centered design of an intelligent virtual agent to strengthen user navigation, prior to undertaking a community-based pragmatic trial of its implementation for equitable practice.

Abstract Background The lack of racial diversity in science, technology, engineering, and mathematics (STEM) disciplines is perhaps one of the most challenging issues in the United States higher education system. The issue is not only concerning diverse students, but also diverse faculty members. One important contributing factor is the faculty hiring process. To make progress toward equity in hiring decisions, it is necessary to better understand how applicants are considered and evaluated. In this paper, we describe and present our study based on a survey of current STEM faculty members and administrators who examined applicant qualifications and characteristics in STEM faculty hiring decisions. Results There are three key findings of the present research. First, we found that faculty members placed different levels of importance on characteristics and qualifications for tenure track hiring and non-tenure track hiring. For example, items related to research were more important when evaluating tenure track applicants, whereas items related to teaching and diversity were more important when evaluating non-tenure track applicants. Second, faculty members’ institutional classification, position, and personal identities (e.g., gender, race/ethnicity) had an impact on their evaluation criteria. For instance, we found men considered some diversity-related items more important than women. Third, faculty members rated the importance of qualifications with diversity, equity, and inclusion (DEI)-related constructs significantly lower than qualifications that did not specify DEI-related constructs, and this trend held for both tenure track and non-tenure track faculty hiring. Conclusions This study was an attempt to address the issue of diversity in STEM faculty hiring at institutions of higher education by examining how applicant characteristics are considered and evaluated in faculty hiring practices. Emphasizing research reputation and postdoctoral reputation while neglecting institutional diversity and equitable and inclusive teaching, research, and service stunt progress toward racial diversity because biases—both implicit and explicit, both positive and negative—still exist. Our results were consistent with research on bias in recruitment, revealing that affinity bias, confirmation bias, and halo bias exist in the faculty hiring process. These biases contribute to inequities in hiring, and need to be addressed before we can reach, sustain, and grow desired levels of diversity.

Background: A Diversity, Equity, and Inclusion (DEI) Team at a university health science library created a checklist for inclusive language and conducted an assessment of their library’s website, LibGuides, and physical and digital signage. Inclusive language was defined as “language that is free from words, phrases or tones that reflect prejudiced, stereotyped or discriminatory views of particular people or groups”. 1BCase Presentation: The 32-item checklist facilitated the identification of gendered language, stereotypes, ableist language, racist language, stigmatizing language, slang, acronyms, and out-of-date terminology regarding physical and mental health conditions. From the library’s website, 20 instances were noted for which improvements were necessary. Out of the 130 LibGuides reviewed, 23 LibGuides had no changes needed and 107 had changes identified relating to language inclusivity (14 strongly recommended changes and 116 suggested changes). Regarding the signage, one flyer was removed for reprinting. 2BConclusion: The checklist enabled the team to implement a number of improvements to the library’s website and LibGuides. The checklist has been shared with Library Technology Services and the wider campus libraries’ Usability Committee for future use, and has also been added to the DEI Team’s LibGuide for use by others outside of the university.

Alternative food networks, such as farmers’ markets and community-supported agricultural and fishery programs, often struggle to reach beyond a consumer base that is predominantly white and affluent. This case study explores seven inclusion strategies deployed by a community-supported fishery program (Fishadelphia, in Philadelphia, PA, USA) including discounting prices, accepting payment in multiple forms and schedules, offering a range of product types, communicating and recruiting through a variety of media (especially in person), and choosing local institutions and people of color (POC) as pickup location hosts. Our analysis indicated that all of these strategies were associated with increased participation of customers of color and/or customers without a college degree. For Asian customers, accepting cash, offering whole fish, recruiting in-person, and POC-hosted pickup locations were key factors. For Black customers, discounted price, accepting cash, offering fillets, and communicating through means other than email were most important. Discounted price and communicating through means other than email were most important for customers without a college degree. Payment method, payment schedule and communication method were highly correlated with other strategies; we suggest that these strategies work in synergy to make the program attractive and feasible to these customers. We consider how Fishadelphia’s inclusion efforts have benefitted from both tactical approaches (i.e., programmatic features) and a structural approaches (i.e., the people and places represented within the project), and suggest that elements of both tactical and structural inclusion can be applied in other contexts. This work is crucial for increasing food access, and underscores the importance of relationships in recruiting diverse customers. [ABSTRACT FROM AUTHOR]

Background: inequalities in travel time, travel cost, and travel risk (ITTRC) can consistently affect access to primary care and social services for disadvantaged and marginalized patients. At the same time, the most disadvantaged patients may face the highest travel time, travel cost, and travel risk due to pre-existing disability, poverty, or other intersectional marginalization. Case Report: to study ITTRC as a confounder which reinforces social and health inequalities, key-informants in the World Health Organization Healthy Cities program, Age-Friendly Cities program, and global EcoCities research initiatives (n=5) were engaged to validate a city planning model towards minimizing ITTRC. A case review of Vancouver, Canada, shows developments which help minimize ITTRC have increased over the last decade, but are not financially-accessible for disadvantaged and marginalized patients. Conclusion: ITTRC can be reduced through city planning, but underlying classism and capitalism must be acknowledged and addressed towards equitable physical access to life opportunities.

Background: The lack of racial diversity in science, technology, engineering, and mathematics (STEM) disciplines is perhaps one of the most challenging issues in the United States higher education system. The issue is not only concerning diverse students, but also diverse faculty members. One important contributing factor is the faculty hiring process. To make progress toward equity in hiring decisions, it is necessary to better understand how applicants are considered and evaluated. In this paper, we describe and present our study based on a survey of current STEM faculty members and administrators who examined applicant qualifications and characteristics in STEM faculty hiring decisions. Results: There are three key findings of the present research. First, we found that faculty members placed different levels of importance on characteristics and qualifications for tenure track hiring and non-tenure track hiring. For example, items related to research were more important when evaluating tenure track applicants, whereas items related to teaching and diversity were more important when evaluating non-tenure track applicants. Second, faculty members' institutional classification, position, and personal identities (e.g., gender, race/ethnicity) had an impact on their evaluation criteria. For instance, we found men considered some diversity-related items more important than women. Third, faculty members rated the importance of qualifications with diversity, equity, and inclusion (DEI)-related constructs significantly lower than qualifications that did not specify DEI-related constructs, and this trend held for both tenure track and non-tenure track faculty hiring. Conclusions: This study was an attempt to address the issue of diversity in STEM faculty hiring at institutions of higher education by examining how applicant characteristics are considered and evaluated in faculty hiring practices. Emphasizing research reputation and postdoctoral reputation while neglecting institutional diversity and equitable and inclusive teaching, research, and service stunt progress toward racial diversity because biases—both implicit and explicit, both positive and negative—still exist. Our results were consistent with research on bias in recruitment, revealing that affinity bias, confirmation bias, and halo bias exist in the faculty hiring process. These biases contribute to inequities in hiring, and need to be addressed before we can reach, sustain, and grow desired levels of diversity. [ABSTRACT FROM AUTHOR]

Purpose: Bullying, harassment, and discrimination (BHD) are prevalent in academic, scientific, and clinical departments, particularly orthopedic surgery, and can have lasting effects on victims. As it is unclear how BHD affects musculoskeletal (MSK) researchers, the following study assessed BHD in the MSK research community and whether the COVID-19 pandemic, which caused hardships in other industries, had an impact. Methods: A web-based anonymous survey was developed in English by ORS Spine Section members to assess the impact of COVID-19 on MSK researchers in North America, Europe, and Asia, which included questions to evaluate the personal experience of researchers regarding BHD. Results: 116 MSK researchers completed the survey. Of respondents, 34.5% (n = 40) focused on spine, 30.2% (n = 35) had multiple areas of interest, and 35.3% (n = 41) represented other areas of MSK research. BHD was observed by 26.7% (n = 31) of respondents and personally experienced by 11.2% (n = 13), with mid-career faculty both observing and experiencing the most BHD. Most who experienced BHD (53.8%, n = 7) experienced multiple forms. 32.8% (n = 38) of respondents were not able to speak out about BHD without fear of repercussions, with 13.8% (n = 16) being unsure about this. Of those who observed BHD, 54.8% (n = 17) noted that the COVID-19 pandemic had no impact on their observations. Conclusions: To our knowledge, this is the first study to address the prevalence and determinants of BHD among MSK researchers. MSK researchers experienced and observed BHD, while many were not comfortable reporting and discussing violations to their institution. The COVID-19 pandemic had mixed-effects on BHD. Awareness and proactive policy changes may be warranted to reduce/eliminate the occurrence of BHD in this community. [ABSTRACT FROM AUTHOR]

Radiology remains one of the least diverse fields in medicine. With increasing understanding of the benefits of workforce diversity on health care outcomes, radiology society leadership and radiologists are engaging in necessary efforts to improve diversity, equity, and inclusion. To date, much of the initiatives have focused on pipeline development and recruitment strategies. Literature from organizational psychologists, human resources and business strategists suggest that incorporation of inclusion could overcome some of the persistent barriers to workforce diversity. Using case studies from real-life residency programs, we describe challenges associated with being a member of an underrepresented minority group in radiology. We illustrate concepts in inclusion, proposing concrete ideas for personal and institutional growth in this area, as a strategy for improving workforce diversity and team effectiveness. [ABSTRACT FROM AUTHOR]

Diversity, equity, inclusion, and justice (DEIJ) are important factors to be considered in medical education, academic and community health centers, and health care policy. DEIJ efforts have been shown to have a strong influence in advancing health equity, yet these efforts tend to fall on a small group of providers, usually of historically marginalized or minority backgrounds (eg, race and ethnicity, gender identity, sexual orientation, religion). To combat this inequity, more research needs to be done to identify where the burden is falling and what strategies can be set in place to counteract this taxing imbalance. Providers should educate themselves on the anti-DEIJ legislation sweeping across the country, recogniz- ing the misinformation, and advocating for efforts pushing back against this movement. Providers can also advocate for ways their institution or practice can reduce the burden for historically marginalized providers by supporting recognition of DEIJ-related efforts in traditional promotional measures or taking on activities allowing for participation in scholarly work that will advance careers. [ Pediatr Ann . 2024;53(10):e354-e357.] .

Healthcare systems must embody equity, diversity, and inclusion (EDI) and, in the event of unfairness, appropriate policies / countermeasures should be enacted. The healthcare system response to the COVID-19 pandemic not only highlighted how socioeconomic disparities affect mortality risk but also posed significant challenges to the successful practice of EDI in healthcare. In light of this, this article was written to provide an overview of EDI, analyze the international efforts to promote it, and suggest strategies for promoting EDI in infectious disease healthcare using COVID-19 as an example. In healthcare settings, equity centers on ensuring patients receive fair treatment regardless of race, gender, age, or socioeconomic status; diversity centers on healthcare providers understanding the uniqueness of patients from different cultural backgrounds and the health barriers they face; and inclusion centers on ensuring patients are treated with respect and given the attention they deserve. During pandemics, social determinants of health (SDOH) greatly impact patient health outcomes and hinder the practice of EDI. Reflecting on the impact of COVID-19, healthcare systems can actively apply EDI in clinical practice to provide to all patients equitable access to healthcare opportunities and outcomes. Practical strategies include establishing EDI committees within healthcare systems, monitoring relevant data, conducting staff training, and continuously addressing the SDOH and needs of marginalized groups to achieve EDI in healthcare.

Background: Professional identity in nursing (PIN) is a multifaceted construct that evolves throughout one's nursing career. As new knowledge about PIN emerges, the influence of diversity, equity, inclusion, and belonging (DEIB) becomes increasingly vital in shaping a nurse's identity., Method: Bronfenbrenner's ecological systems theory is used to illustrate the complex, reciprocal, and intersecting influences of DEIB in the transformational process of becoming a nurse., Results: The authors provide an in-depth analysis of the nexus of DEIB and PIN conceptual model, examine reciprocal relationships between DEIB and the individual and collective PIN, offer a detailed case study for the application of DEIB and PIN, and make recommendations for implementing the conceptual model., Conclusion: The model may be used to integrate DEIB and PIN by nurses in all settings. [ J Contin Educ Nurs. 2024;55(10):493-499.] .

Objective: To compare perceptions of underrepresented minorities (URM), non-URM people of color (POC), and nonminoritized pharmacy faculty in academia in relation to workplace diversity, equity, inclusion, and anti-racism (DEIA) landscape in the United States., Methods: This study utilized the DEIA Faculty Perceptions of College Climate (FPCC) scale, which was developed and validated by the authors. The FPCC scale was used to investigate perceptions of pharmacy faculty from the American Association of Colleges of Pharmacy membership directory regarding DEIA within their respective academic pharmacy institutions. Demographic differences were examined using a Pearson chi-square test, while response disparities in FPCC questions were analyzed with a one-way ANOVA., Results: A total of 846 respondents met the inclusion criteria for the study and were included in the analysis. Results indicate disparities in perceptions within all 4 DEIA domains of the FPCC survey among the 3 demographic groups., Conclusion: This study uncovers significant differences in how pharmacy faculty perceive DEIA within pharmacy education, with nonminoritized faculty expressing more positive views compared to their URM and non-URM counterparts. These results emphasize the need for focused interventions and institutional support to bridge DEIA disparities, emphasizing the importance of fostering an inclusive academic environment to enhance faculty well-being and empower the pharmacy profession to meet diverse needs more effectively., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Purpose: Equity, Diversity, and Inclusion (EDI) initiatives within critical care research are limited by a lack of resources and inconsistent and rapidly changing language. The Canadian Critical Care Trials Group (CCCTG) is committed to modelling EDI for the critical care community through its programming, communications, protocols, and policies. The objective of developing the EDI glossary of sociodemographic determinants of health described here was to provide a resource for critical care professionals to support broader equity initiatives and to promote education and awareness about inclusive language., Methods: Through literature review, we identified EDI-related sociodemographic determinants of health, defined as sociodemographic factors that are associated with disparities in health care and health outcomes, with a focus on critical care medicine. For each sociodemographic determinant of health, we identified umbrella terms (defined as domains) and subterms/constructs that are related to these domains. We designed the glossary collaboratively with the CCCTG EDI working group, patient and family partnerships committee, and executive committee, which included diverse knowledge users such as researchers, clinicians, and patient and family partners., Results: We report on 12 sociodemographic determinants of health domains including age, sex, gender, sexuality, race and ethnicity, income, education, employment status, marital status, language, disability, and migration status. Each domain (e.g., sex) contains relevant subterms such as male, female, intersex. For each domain, we provide examples of disparities in health care and health outcomes with a focus on critical care medicine., Conclusions: This EDI glossary of sociodemographic determinants of health serves as a nonexhaustive resource that may be referenced by critical care researchers, research coordinators, clinicians, and patient and family partners. The glossary is an essential step to raising awareness about inclusive terminology and to fostering and advancing equity in critical care medicine., (© 2024. Canadian Anesthesiologists' Society.)

Background and Objective: Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may persist for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socioeconomically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC health care and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil., Methods: Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in 3 guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of health-care access., Results: The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our 3 principles through survey content, instrument design, and administration. Six hundred fifty-one participants with diverse LC symptoms, demography, and socioeconomic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income., Conclusion: By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them., Competing Interests: Declaration of competing interest M.C.P. and M.M. are recipients of productivity fellowships from the Brazilian National Council of Research and Technological Development (CNPq). There are no competing interests for any other author., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Race-based associations in medicine are often taught and learned early in medical education. Students and residents enter training with implicit and explicit biases from their educational environments, further propagating biases in their practice of medicine. Health disparities described out of context can lead trainees to develop harmful stereotypes. Surgery leadership created a model to implement educational opportunities, resources, and outcomes in an academic Department of Surgery., Methods: An ad hoc committee of surgical faculty, residents, and medical students was assembled. Educational goals and objectives were established via Diversity, Equity & Inclusion (DEI) committee: 1) incorporate race-conscious awareness and learning into the academic surgery curriculum for residents and medical students, 2) cooperatively learn about race in clinical and surgical decision-making, 3) incorporate learning about social determinants of health that lead to racial and ethnic inequities, and 4) develop tailored learning in order to recognize and lessen health inequities., Phase I: DEI Committee formed of surgery faculty, residents, medical students, and support staff. Activities of the committee, goal development, a DEI mission statement, training, and education overview were formulated by committee members., Phase Ii: A strengths, weaknesses, opportunities, and threats analysis was created for assessment of diversity and inclusion, and race-conscious learning in the surgery clerkship and residency curriculum. Phase III: Baseline assessment to: 1) understand opinions on DEI in the Department of Surgery, 2) assess current representation within the department workforce, and 3) correlate workforce to the make-up of patient population served. Development and restructuring of the surgery education curriculum for medical students and residency created jointly with the Racism and Bias Task Force., Results: Educational programs have been implemented and delivered for: 1) appropriate inclusion of race-conscious learning such as image diversity, as well as race-based association, 2) social determinants of health in the care of patients, 3) racial disparities in surgical outcomes, 4) introduction of concepts on implicit bias, 5) opportunities for health equity rounds, and 6) inclusion in committees and leadership positions., Conclusions: Awareness of clinical faculty and learners to race-conscious and antibias care is paramount to recognizing and addressing biases. Knowledge of sociocultural context may allow learners to develop a socioculturally sensitive approach for patient education, and to more broadly measure surgical outcomes. Race-conscious education should be implemented into teaching curriculum as well as professional development in attempts to close the gap in health-care equity., (Published by Elsevier Inc.)

Interweaving diversity, equity, and inclusion (DEI) into the standards for accreditation requires veterinary schools to review their curriculum and determine what framework works best for them to implement those changes. The Competency-Based Veterinary Education framework is one that is available via the American Association of Veterinary Medical Colleges (AAVMC) to reach those standards. Five standards have DEI components versus having a single standard of DEI as previously Standards of Accreditation by the Council on Education had approved., Competing Interests: Disclosure The author has no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Medical graduates applying to Residency through the Canadian Resident Matching System (CaRMS) utilize the internet to gather information on programs and their overarching Postgraduate Medical Education (PGME) Office. This study aims to evaluate how PGME websites across Canada convey their commitment to equity, diversity, and inclusion (EDI) through their website features., Methods: Cross-sectional analysis of the 17 Canadian PGME websites against 20 EDI criteria based on contemporary literature, across five domains: leadership and governance, recruitment, accommodations, community engagement, and pathways to entry. Non-parametric testing was conducted to explore the relationship between EDI performance and municipal population diversity and geographic region., Results: The evaluation of PGME websites, policies, reports, and plans revealed a mean score of 8.65/20 (SD = 3.00), with scores ranging from a minimum of 4/20 to a maximum of 13/20, indicating variability in EDI representation. Specifically, the domain of leadership and governance demonstrated the highest mean proportion of completed criteria (51%), while community engagement had the lowest (24%). Notably, 9 out of 17 PGME websites (53%) met at least 10 EDI criteria. Analysis by geographic region demonstrates significant mean differences (p = 0.02), with Ontario (10.50, SD = 2.17) and Western Provinces (11.00, SD = 0.00) scoring notably higher than Quebec (4.50, SD = 0.58), the Prairies (8.50, SD = 2.12), and the Atlantic region (8.00, SD = 2.83)., Conclusions: The assessment of Canadian PGME websites reveals varying levels of commitment to EDI. While many programs exhibit strong EDI representation in mission statements, access to mental health services, and anti-discrimination policies, there are notable gaps in leadership messaging, diverse interview panels, family-friendly policies, and deliberate recruitment of underrepresented groups. Regional differences highlight the need for sharing best practices to promote inclusivity across the country. Improving EDI efforts on PGME websites can promote the recruitment and retention of a diverse resident population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bondok et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Interventions that aim to address equity, diversity, and inclusion (EDI) within the health professions often strive to promote the retention, recruitment, and success of individuals from historically underrepresented groups, who often belong to the same groups experiencing underservicing in health care. A pilot study aimed to examine the impact of ongoing EDI initiatives at Dalhousie University in Nova Scotia, Canada by exploring sense of belonging and curricular inclusion/representation from the perspectives of enrolled students. Intersectionality Theory was operationalized by way of considering the relational and contextual nature of marginalization. Results showed differences in perceptions of impacted sense of belonging and curricular inclusion/representation of diverse groups between respondents in the underrepresented subgroup as compared to their overrepresented counterparts. Differences in underrepresented and overrepresented subgroups' perceptions of impacted sense of belonging and curricular inclusion/representation suggest a need for further research to better understand the impact of EDI interventions on nursing students., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Program websites play a crucial role in providing information to prospective residency applicants. This research assesses the extent to which Canadian ophthalmology residency programs demonstrate their commitment to equity, diversity, and inclusion (EDI) through their websites and identifies areas for potential improvement., Methods: A cross-sectional analysis of websites affiliated with 15 accredited Canadian ophthalmology residency training programs was performed. A score was assigned based on 16 EDI elements derived from recent literature. The relationship between program website EDI elements with language, geography, and regional population diversity was explored., Results: Of the 15 Canadian ophthalmology residency programs, 12 (80%) met at least 1 of 16 EDI elements, with a mean program score of 2.4 (SD = 1.92). The program that attained the highest score met 7 of 16 EDI elements. Anglophone programs had a higher mean score (2.92; SD = 1.78) when compared with their Francophone counterparts (0.33; SD = 0.58; p = 0.023). No significant difference was found between programs in western, central, and eastern Canada (p = 0.86). The regional minorities proportion associated with each program was not found to influence scores (p = 0.088)., Conclusions: EDI elements were seldom addressed on Canadian ophthalmology residency program affiliated websites. We propose recommendations in 4 domains: showcasing team diversity, clear discourse in recruitment, inclusive resources, and program organization. Improving EDI visibility on program websites through revisions of existing websites or through creation of new promotional websites may foster recruitment of a diverse resident body., (Copyright © 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background: Simulated cases are widely used in medical education to develop clinical reasoning skills and discuss key topics around patient care. Such cases present an opportunity to demonstrate real world encounters with diverse patient and health provider identities, impacts of social and structural determinants of health, and demonstrate a generalist approach to problems. However, despite many calls-to-action for medical schools to better incorporate equity, diversity and inclusion (EDI) and generalism, it remains difficult to evaluate how well these goals are being met., Methods: A quality improvement project was completed at a single medical school to evaluate the domains of generalism and EDI within simulated cases used in the preclinical curriculum. Generalism was evaluated using the Toronto Generalism Assessment Tool (T-GAT). EDI was evaluated using a locally developed novel tool. Analysis included descriptive statistics and Pearson correlation coefficient., Results: A total of 49 simulated cases were reviewed. Twelve generalism and 5 EDI items were scored on a 5-point Likert scale, with higher scores indicating better demonstration of generalism or EDI within a case. Average generalism score across all cases was 45.6/60. Average EDI score across all cases was 11.7/25. Only 21/49 cases included representation of one or more diverse identity categories. The most common diverse identity represented was non-white races/ethnicities, and the identity represented the least was diversity in language fluency. Generalism and EDI scores demonstrated a weak positive correlation (R 2  = 0.25)., Conclusions: Quantitative evaluation of simulated cases using specific generalism and EDI scoring tools was successful in generating insight into areas of improvement for teaching cases. This approach identified key content areas for case improvement and identities that are currently underrepresented in teaching cases. Similar approaches could be feasibly used by other medical schools to improve generalism and EDI in teaching cases or other curricular materials.

How often a researcher is cited usually plays a decisive role in that person's career advancement, because academic institutions often use citation metrics, either explicitly or implicitly, to estimate research impact and productivity. Research has shown, however, that citation patterns and practices are affected by various biases, including the prestige of the authors being cited and their gender, race, and nationality, whether self-attested or perceived. Some commentators have proposed that researchers can address biases related to social identity or position by including a Citation Diversity Statement in a manuscript submitted for publication. A Citation Diversity Statement is a paragraph placed before the reference section of a manuscript in which the authors address the diversity and equitability of their references in terms of gender, race, ethnicity, or other factors and affirm a commitment to promoting equity and diversity in sources and references. The present commentary considers arguments in favor of Citation Diversity Statements, and some practical and ethical issues that these statements raise.

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Evidence syntheses for advancing equitable traumatic brain injury (TBI) research, policy, and practice presents formidable challenges. Research and clinical frameworks are currently not specific to equity, diversity, and inclusion considerations, despite evidence that persons with TBI live in societies in which power imbalances and systems of social dominance may privilege some people and marginalize others. The present protocol outlines a strategy for a research program, supported by the Canadian Institutes of Health Research, that explores the integration of PROGRESS-Plus parameters in research with the goal of advancing open-science databases and tools to improve our understanding of equity in cognitive and brain health outcomes in TBI. PROGRESS-Plus is a framework outlining social, economic, and cultural parameters that may influence health opportunities and outcomes (e.g., place of residence, race, occupation, gender, etc.). A multistep research program is proposed to support three objectives: (1) organizing existing data on TBI-induced changes in cognition and brain health into a template to facilitate future research, including research using machine learning techniques; (2) updating published evidence with a more rigorous approach to the consideration of PROGRESS-Plus parameters; and (3) mobilizing knowledge on the current state of evidence that is relevant, equitable, and accessible. This program facilitates partnerships with knowledge users across clinical, research, academic, and community sectors to address the three research objectives through a unifying workflow of exchange, synthesis, and knowledge mobilization. We anticipate that this global collaboration between topic experts and community leaders in equity in brain health will add significant value to the field of TBI by promoting equity-transformative advancements in knowledge synthesis, policy, and practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sant’Ana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Clinical trial participation across disease areas, including Alzheimer's disease (AD), has been biased towards White participants of European ancestry. To support clinical decision-making across diverse populations, we must recognize and address barriers to trial participation. To inform the design of ALUMNI AD, a trial focused on historically underrepresented AD populations, we held advice-seeking fora with key stakeholders to understand barriers and identify potential solutions to maximize trial participation of underrepresented racial and ethnic groups in the US. Strategies identified from this process include: obtaining and implementing recommendations from community stakeholders; establishing a simple and inclusive prescreening and screening process; supporting participants and care partners; identifying and activating community-centric clinical sites; and demonstrating community commitment. While ALUMNI AD did not commence, we hope that our insights could be incorporated into future studies to improve diversity, equity, and inclusion in AD clinical research., Funding: This study was sponsored by Genentech, Inc., Competing Interests: AWB, HL, BA, GAR, RG, and SSA are employees of Genentech, Inc. and shareholders of F. Hoffmann-La Roche Ltd. SAB, JNH and MG are consultants for Genentech, Inc. SM has received consulting fees from Alzheimer's Clinical Trials Consortium (ACTC), Alzheimer's Therapeutic Research Institute (ATRI) and Genentech, Inc. MWP has received a Foundation award for Outreach from Alzheimer's Foundation of America; consulting fees from Eisai, Eli Lilly, and Genentech, Inc.; support for attending meetings and/or travel from Eli Lilly; is a member of the Board of Directors for Alzheimer's Foundation of America and AG Rhodes Nursing and Rehabilitation; and has provided approval for and reviewed CME training sessions for accreditation for the Commission on Continuing Professional Development, American Academy of Family Physicians. JEM has received funding from National Institute of Aging, Alzheimer's Association, Eisai, GHR Foundation, Eli Lilly, Cerevel Therapeutics LLC, GSK Research & Development Limited, Merck Sharp & Dohme LLC, Alzheimer's Drug Discovery Foundation, Cognition Therapeutics, Inc., Suven Life Sciences Ltd, Vivoryon Therapeutics; consulting fees from Genentech, Inc., AARP Global Council on Brain Health (GCBH) and “Staying Sharp” Scientific Advisory Board, ACADIA, AiOmed, Corium, Exciva, ICG Pharma, Ironshore Pharmaceuticals, Lundbeck, Praxis Bioresearch, Otsuka/Avanir, Sumitomo Pharma Co Ltd, Sygnature Discovery; honoraria for ACADIA; meeting support for AARP Global Council on Brain Health (GCBH), AiOmed, Alzheimer's Clinical Trials Consortium (ACTC); and is a scientific advisor of AARP—“Staying Sharp” Scientific Advisory Board; an advisory board member for ACADIA and Exciva; a member of the Governance Committee for AARP–Global Council on Brain Health; a steering committee member for Alzheimer's Therapeutic Research Institute (ATRI), Alzheimer's Clinical Trials Consortium (ACTC), and Elder Court; a board member for Alzheimer's Association SC Chapter and Technology Accelerator Company (TAC); a member of the International Psychogeriatric Association (IPA); a DSMB member for NAB-It: Nabilone for Agitation Blinded Intervention Trial; and a shareholder of BioPharma Connex, NeuroQuest, and Recruitment Partners. JS is an employee of Roche Products Ltd and a shareholder of F. Hoffmann-La Roche Ltd. RSD was an employee of F. Hoffmann-La Roche Ltd and Genentech, Inc., and a shareholder in F. Hoffmann-La Roche Ltd., (© 2024 The Authors.)

Diversity, equity, inclusion, and accessibility (DEIA) are foundational principles for clinical trials and medical research. In rare diseases clinical research, where numbers of participants are already challenged by rarity itself, maximizing inclusion is of particular importance to clinical trial success, as well as ensuring the generalizability and relevance of the trial results to the people affected by these diseases. In this article, we review the medical and gray literature and cite case examples to provide insights into how DEIA can be proactively integrated into rare diseases clinical research. Here, we particularly focus on genetic diversity. While the rare diseases DEIA literature is nascent, it is accelerating as many patient advocacy groups, professional societies, training and educational organizations, researcher groups, and funders are setting intentional strategies to attain DEIA goals moving forward, and to establish metrics to ensure continued improvement. Successful examples in underserved and underrepresented populations are available that can serve as case studies upon which rare diseases clinical research programs can be built. Rare diseases have historically been innovation drivers in basic, translational, and clinical research, and ultimately, all populations benefit from data diversity in rare diseases populations that deliver novel insights and approaches to how clinical research can be performed., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)