Mapping the Void: Understanding Diversity, Equity, and Inclusion Training in Medicine.

Objective: To delineate how identity-based bias exposure evolves with rank and/or context among health care workers, and assess their attitudes toward existing diversity, equity, and inclusion (DEI) education.

Background: Although DEI training is widely mandated for health care workers, few studies examine how clinicians' needs evolve across a career, how context impacts recipients' ability to respond, or how well existing programs adapt to individual contexts.

Methods: A 54-question electronic survey was distributed during Morbidity and Mortality conferences beginning in December 2020. Descriptive statistics were performed regarding respondents' bias exposure across rank, perceptions regarding existing training's fidelity to recipients' lived experience, and ability to confer useful response strategies.

Results: This study included 648 individuals (65.6% White; 50.2% women) practicing in mostly academic medical centers (70.6%). Respondents affirmed that discrimination was common, with half (320, 49.4%) reporting that they experienced bias at least monthly. Among people of color, the proportion reporting monthly exposure decreased with rank. Women of color experienced the biggest drop (74% as residents/fellows down to 11% in late career). Broadly, participants reported the greatest discomfort in addressing subtle bias from patients or high-ranked individuals, and this did not uniformly improve with seniority. Finally, although 478 (73.8%) individuals reported receiving DEI training, 51.3% of respondents reported online DEI modules had little utility. Shortcomings included that training focused on individual rather than structural solutions and that it did not confer response strategies users could reliably employ.

Conclusions: Identity and context strongly influence both clinicians' exposure and ability to respond to bias in the hospital environment, independent of seniority. Existing DEI training fails to account for this nuance, ultimately diminishing its utility to clinicians.