Diversity, equity, and inclusion (DEI) and health equity (HE) education in hematology/oncology (HO) fellowship: A longitudinal curriculum.
Authors: Ansari Norin , Fanucci Kristina , Burtness Barbara , Goldberg Sarah B. , Hurwitz Michael E. , Podoltsev Nikolai Alexandrovich , Lee Alfred Ian , Kunz Pamela L. 
Published: June 2023

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Background: The medical workforce remains markedly less diverse than the patients we care for, and outcomes disparities persist. This highlights the need for DEI efforts and HE education. In 2021, we implemented a DEI curriculum in the HO fellowship at Yale Cancer Center (YCC) and found improvements in our fellows’ upstander responses. We present an assessment 1 year after initiation of this series and we share our longitudinal 3-year DEI/HE curriculum and other institutional steps taken to improve equity. Methods: An anonymous survey assessing DEI/HE needs, experiences with and comfort level addressing discrimination, and preferences for curriculum was emailed to all YCC HO fellows. 1st year fellows had no formal DEI education prior to the survey. Senior fellows had completed 1 year of the fellowship’s DEI series. Results: 23 fellows (79%) responded, including 8 1st year and 13 senior fellows (2 unknown). Most fellows had experienced (78%) or witnessed (87%) some form of discrimination. Notably, 1st year fellows felt under-equipped to navigate bias and microaggressions compared to senior fellows. 1st year fellows reported a mean confidence score of 2.5/5 navigating these events when experienced personally and 2.9/5 when directed at others, compared to senior fellows (mean confidence scores 3 and 3.2 respectively). Fellowship DEI education was perceived as important (mean 8.6/10). When asked which DEI/HE topics they would be interested in learning about, the most popular choices among the 23 fellows were cancer treatment and outcomes disparities (78%) and bystander training (70%). They indicated lectures from field experts (65%), affinity groups (57%), small group discussions (52%), and advocacy education (52%) would be useful to them. The chief fellows convened a series of discussions with faculty and field experts, which led to creation of a 3-year longitudinal DEI/HE curriculum. This includes an annual cancer disparities lecture and bystander training session, and 2-4 rotating lectures per year covering implicit bias training, issues of race, gender, LGBTQIA+, disability, and religion in the workforce and in patients’ experiences, pay and promotion disparities, and financial toxicity for patients. YCC and fellowship leadership have also implemented a DEI lecture series, increased recruitment of under-represented in medicine (URiM) physicians, established an URiM mentorship group and a diversity enhancement program for rotations for URiM medical students, and encouraged community engagement. Conclusions: DEI/HE education at all levels is essential for fostering equity in the workplace and patient care. Implementation of a longitudinal curriculum in parallel with other YCC initiatives has improved fellows’ confidence in navigating bias and microaggressions. This curriculum can serve as a guide for other programs developing DEI/HE education.