• Chelsea A Harris, Andrew Vastardis, Chad Jobin, and Lesly Dossett.
• Assistant Professor of Surgery in the Division of Plastic Surgery at the University of Utah.
• Ann. Surg. 2024 Dec 9.

ObjectiveTo delineate how identity-based bias exposure evolves with rank and/or context among healthcare workers, and assess their attitudes toward existing DEI education.BackgroundAlthough Diversity, Equity and Inclusion (DEI) training is widely mandated for healthcare workers, few studies examine how clinicians' needs evolve across a career, how context impact recipients' ability to respond, or how well existing programs adapt to individual context.MethodsA 54-question electronic survey was distributed during Morbidity & Mortality conferences beginning 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.ResultsThis 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 experiencing the biggest drop: (74% as residents/fellows down to 11% in late career). Broadly, participants reported 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.ConclusionsIdentity 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.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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