ImportanceMinoritized racial and ethnic groups remain underrepresented in medicine (UIM) compared with the general population. Although many residency programs want to train a diverse group of individuals, methods for implementation are not fully established.ObjectiveTo describe the implementation and restructuring of the Boston Combined Residency Program (BCRP) Diversity Council and evaluate the association between restructuring the BCRP Diversity Council and the number of UIM interns.Design, Setting, and ParticipantsA retrospective cohort study was conducted on a large academic pediatric residency program at Boston Children’s Hospital and Boston Medical Center. Interns who matched in the BCRP from March 17, 2011, to March 18, 2021, were included. Interns who matched in an affiliated medicine-pediatrics residency were excluded because they are not universally exposed to the same recruitment efforts as individuals in the other BCRP tracks.ExposureBecause the BCRP Diversity Council was restructured in 2016, 2011-2016 was defined as the prerestructuring era and 2017-2021 as the postrestructuring era.Main Outcomes and MeasuresThe primary outcome was the proportion of interns who self-identified as UIM.ResultsA total of 516 BCRP interns from 2011 to 2021 were included. A total of 62 individuals (12.0%) identified as racial and ethnic identities UIM (ie, American Indian/Alaska Native, Black/African American, Hispanic/Latino, and Native Hawaiian/Pacific Islander). During the 6-year prerestructuring Diversity Council era, 27 of the 275 BCRP interns (9.8%) were UIM; 35 of 241 BCRP interns (14.5%) were UIM during the 5-year restructured Diversity Council era (χ2 P = .10).Conclusions and RelevanceIn this cohort study, the number of UIM interns was higher after the BCRP Diversity Council was restructured, although the difference was not statistically significant. As the magnitude of the Diversity Council’s influence is multidimensional, perhaps studying additional aspects would have better captured its impact. The BCRP Diversity Council has expanded innovative recruitment initiatives, supported efforts to improve the resident experience, and collaborated with the residency and institutional leadership to promote an inclusive and antiracist learning environment.
Introduction: Survival disparities in adult in-hospital cardiac arrest (IHCA) are well-described with decreased survival in Black patients. Pediatric literature from AHA’s GWTG—Resuscitation did not show this association, possibly due to differences in IHCA definitions and patient population. We aimed to investigate associations between outcomes after pediatric CPR and race/ethnicity and insurance payer status in a nationally representative database. We hypothesized non-White race/ethnicity, compared to white race, and public insurance, compared to private insurance, would be associated with lower rates of survival. Methods: Retrospective cohort study of subjects ≤18 years with CPR procedure codes in the 1997- 2019 editions of the Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID). We excluded subjects missing race/ethnicity, insurance payer or disposition and subjects with in-patient transfer as their disposition. We evaluated hypothesized associations with weighted mixed-effect logistic regression clustered by hospital. Hospital (size, teaching/non-teaching institution, rural/urban, region) and patient (age, KID cohort year, sex, insurance payer, complex chronic condition, median income quartile) confounders were considered fixed effects. Individual hospitals were treated as a random effect. Results: Our cohort included 27,332 children admitted to 3,353 centers. Univariable and multivariable modeling showed higher odds of in-hospital mortality for all non-White categories compared to white race: Black (aOR 1.20, 95% CI 1.08-1.34; p<0.001), Hispanic (aOR 1.17, 95%CI 1.05-1.31; p=0.006), and other race/ethnicity (aOR 1.37, 95%CI 1.20-1.57; p<0.001). There was no difference in mortality between those with public and private insurance. Conclusions: In contrast to previously published data, after risk- and reliability-adjustment of individual and hospital-level effects, children receiving CPR with non-White race/ethnicity had higher mortality odds. These findings suggest the presence of race/ethnicity-based disparities in pediatric IHCA mortality, the mechanisms of which should be explored.
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