key: cord-0772845-ju5qucen
authors: Luercio, Marcella; Ward, Valerie L.; Sectish, Theodore C.; Mateo, Camila M.; Michelson, Catherine D.
title: One Size Does Not Fit All: Implementation of an Equitable and Inclusive Strategic Response to Address Needs of Pediatric Resident Physicians during the COVID-19 Crisis
date: 2020-10-14
journal: J Pediatr
DOI: 10.1016/j.jpeds.2020.10.023
sha: e389cb629bfcc5db41e9954f6fc761c9b0abe527
doc_id: 772845
cord_uid: ju5qucen

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I confirm that I am an author on the above mentioned manuscript, which is currently being submitted to The Journal of Pediatrics. My authorship contribution consisted of the following (note: authors must meet all four conditions): incidences of microaggressions and bias; feelings of isolation; and personal, professional, and financial hardships, all of which may be exacerbated in times of crisis. 3, 4 Taking this into account, the residency-wide COVID-19 strategic response was created and reviewed through a lens of equity and inclusion to ensure it addressed the diverse needs of resident physicians in a large pediatric residency program. We describe the creation of this equitable and inclusive strategic response, lessons learned that remain relevant beyond the pandemic, and suggestions for further areas of work.

As our program worked to develop a residency-wide strategic response to the COVID-19 crisis, a planning committee of program leadership, faculty, and chief residents was convened. Four out of 14 of the committee members (29%) were from backgrounds underrepresented in medicine. The aim of this committee was to evaluate and amend the residency-wide crisis response to ensure it explicitly addressed pediatric residents who might be disproportionately affected by the pandemic due to new or exacerbated stresses (personal, financial, and work-related). To better understand the needs of these residents, we solicited input from our hospital's Office of Health Equity and Inclusion and reviewed published resources describing inclusive solutions during times of crisis. 3 We also sought to understand individual needs by encouraging residents to submit requests directly to chief residents, program leaders or anonymously via an electronic submission system. After identifying these needs, the committee then reviewed the residency-wide COVID-19 response and added specific supports meant to J o u r n a l P r e -p r o o f 3 address the unique needs of those who could be disproportionately affected. The final equitable and inclusive COVID-19 strategic response was distributed to all residents electronically to ensure that any resident needing additional support could take advantage of the resources, given specific needs are difficult to predict.

The planning committee found that the residency-wide COVID-19 response contained many comprehensive resources to benefit all residents. families, and partners belonging to these groups may also have increased fears of falling ill from COVID-19 and being subjected to bias by providers or the healthcare system. In addition to ensuring 24/7 access to mental health support via virtual visits and comprehensive health and wellness resources (eg, exercise classes, meditation, and mindfulness guides) for every resident, we also used this time to redistribute institutional and program policies on maltreatment and discrimination to residents and faculty. These policies outline zero tolerance for these behaviors and delineate how residents can report events. (eg, older family members in multigenerational homes, chronic health conditions of residents or partners, pregnancy or young infants at home). Seven residents met with program leadership to discuss this short-term virtual work option and five opted into the rotation.

When longstanding health inequities related to race/ethnicity and socioeconomic status were exposed by COVID-19, three resident-led seminars were created on these topics and prioritized in the existing virtual seminar schedule.

Despite many competing interests during COVID-19, we worked to prioritize our commitment to equity, diversity, and inclusion by creating a "one size does not fit all" crisis response to serve the needs of our diverse resident community. We believe we were successful in being intentional in our efforts, using creative solutions within our available resources, and eliciting broad perspectives.

It is known that crises often affect marginalized groups disproportionately. 3 Hence, we deliberately set out early in the COVID-19 pandemic to proactively anticipate, solicit, and address residents' needs before they manifested. We focused on creative solutions and the use of available resources. For example, we were able to provide financial assistance to residents by deploying a fund that existed to support work-family balance.

To incorporate broad perspectives, we elicited input from residency leaders, chief J o u r n a l P r e -p r o o f 6 residents, and our hospital's Office of Health Equity and Inclusion, while also encouraging residents to submit requests for their needs. Obtaining diverse opinions from key stakeholders has been shown to be a successful strategy for creating equitable and inclusive solutions. 3 Razack and Philibert further advocate for using the resident voice in decision-making. 9 They suggested that inclusive medical training programs "display the courage to co-create with their learners" and minimize hierarchical decision-making. 9 In creating our crisis response, the chief residents were directly involved and all residents were encouraged to submit anonymous or nonanonymous requests. This approach allowed individuals, including residents as well as financial hardships. 3, 4 Failing to recognize these existing challenges poses a serious threat to creating inclusive solutions to address residents' needs, which must be assessed in the context of their personal, social, cultural, and institutional environments.

In the same way that we cannot expect a treatment plan to work for every patient with diagnosis 'X,' we cannot expect a "one size fits all" solution to meet every individual resident's needs. Only after adopting a "one size does not fit all" framework, can we begin to achieve equity in our training environments, where solutions and opportunities are accessible to all.

Program leaders, as they respond to this crisis, the next, and the seasonal challenges of residency leadership, should work intentionally towards crafting equitable, inclusive, and actionable solutions. Whenever possible, these solutions should be proactive rather than reactive, anticipating residents' needs before they arise. Using this intentional, forward-thinking approach, we can advance our mission of recruiting and training the J o u r n a l P r e -p r o o f 8 next generation of diverse physicians, while promoting equitable and inclusive training environments that embrace the principle, "one size does not fit all."

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