PMID- 38381434 OWN - NLM STAT- MEDLINE DCOM- 20240222 LR - 20240321 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 7 IP - 2 DP - 2024 Feb 5 TI - Development of a Tool to Measure Student Perceptions of Equity and Inclusion in Medical Schools. PG - e240001 LID - 10.1001/jamanetworkopen.2024.0001 [doi] LID - e240001 AB - IMPORTANCE: Creating an inclusive and equitable learning environment is a national priority. Nevertheless, data reflecting medical students' perception of the climate of equity and inclusion are limited. OBJECTIVE: To develop and validate an instrument to measure students' perceptions of the climate of equity and inclusion in medical school using data collected annually by the Association of American Medical Colleges (AAMC). DESIGN, SETTING, AND PARTICIPANTS: The Promoting Diversity, Group Inclusion, and Equity tool was developed in 3 stages. A Delphi panel of 9 members identified survey items from preexisting AAMC data sources. Exploratory and confirmatory factor analysis was performed on student responses to AAMC surveys to construct the tool, which underwent rigorous psychometric validation. Participants were undergraduate medical students at Liaison Committee on Medical Education-accredited medical schools in the US who completed the 2015 to 2019 AAMC Year 2 Questionnaire (Y2Q), the administrations of 2016 to 2020 AAMC Graduation Questionnaire (GQ), or both. Data were analyzed from August 2020 to November 2023. EXPOSURES: Student race and ethnicity, sex, sexual orientation, and socioeconomic status. MAIN OUTCOMES AND MEASURES: Development and psychometric validation of the tool, including construct validity, internal consistency, and criterion validity. RESULTS: Delphi panel members identified 146 survey items from the Y2Q and GQ reflecting students' perception of the climate of equity and inclusion, and responses to these survey items were obtained from 54 906 students for the Y2Q cohort (median [IQR] age, 24 [23-26] years; 29 208 [52.75%] were female, 11 389 [20.57%] were Asian, 4089 [7.39%] were multiracial, and 33 373 [60.28%] were White) and 61 998 for the GQ cohort (median [IQR] age, 27 [26-28] years; 30 793 [49.67%] were female, 13 049 [21.05%] were Asian, 4136 [6.67%] were multiracial, and 38 215 [61.64%] were White). Exploratory and confirmatory factor analyses of student responses identified 8 factors for the Y2Q model (faculty role modeling; student empowerment; student fellowship; cultural humility; faculty support for students; fostering a collaborative and safe environment; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation) and 5 factors for the GQ model (faculty role modeling; student empowerment; faculty support for students; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation). Confirmatory factor analysis indicated acceptable model fit (root mean square error of approximation of 0.05 [Y2Q] and 0.06 [GQ] and comparative fit indices of 0.95 [Y2Q] and 0.94 [GQ]). Cronbach alpha for individual factors demonstrated internal consistency ranging from 0.69 to 0.92 (Y2Q) and 0.76 to 0.95 (GQ). CONCLUSIONS AND RELEVANCE: This study found that the new tool is a reliable and psychometrically valid measure of medical students' perceptions of equity and inclusion in the learning environment. FAU - Boatright, Dowin AU - Boatright D AD - Department of Emergency Medicine, New York University Grossman School of Medicine, New York. FAU - Nguyen, Mytien AU - Nguyen M AD - Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut. FAU - Hill, Katherine AU - Hill K AD - Yale School of Medicine, New Haven, Connecticut. FAU - Berg, David AU - Berg D AD - Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut. FAU - Castillo-Page, Laura AU - Castillo-Page L AD - The National Academies of Sciences, Engineering, and Medicine. FAU - Anderson, Nientara AU - Anderson N AD - Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut. FAU - Agbelese, Victoria AU - Agbelese V AD - Yale School of Medicine, New Haven, Connecticut. AD - Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut. FAU - Venkataraman, Shruthi AU - Venkataraman S AD - Department of Emergency Medicine, New York University Grossman School of Medicine, New York. FAU - Saha, Somnath AU - Saha S AD - Section of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Schoenbaum, Stephen C AU - Schoenbaum SC AD - Josiah Macy Jr Foundation, New York, New York. FAU - Richards, Regina AU - Richards R AD - Office of Diversity, Equity, Inclusion and Community Engagement, University of Colorado Anschutz Medical Campus, Aurora. FAU - Jordan, Ayana AU - Jordan A AD - Department of Psychiatry, New York University Grossman School of Medicine. FAU - Asabor, Emmanuella AU - Asabor E AD - Yale School of Medicine, New Haven, Connecticut. AD - Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut. FAU - White, Marney A AU - White MA AD - Yale School of Medicine, New Haven, Connecticut. AD - Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut. LA - eng PT - Journal Article DEP - 20240205 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 SB - IM MH - Adult MH - Female MH - Humans MH - Male MH - Young Adult MH - Asian MH - Climate MH - Educational Status MH - *Schools, Medical MH - *Students, Medical MH - Diversity, Equity, Inclusion MH - White PMC - PMC10882418 COIS- Conflict of Interest Disclosures: Dr Schoenbaum reported being a former employee of Josiah Macy Jr Foundation during the conduct of the study. Dr Jordan reported receiving grants from Substance Abuse and Mental Health Services Administration, grants from National Institute on Alcohol Abuse and Alcoholism, grants from National Institute on Drug Abuse, and grants from National Institutes of Health (NIH) outside the submitted work. Dr Asabor reported serving on the American Medical Association external health equity research advisory board. Dr White reported receiving grants from Josiah Macy Jr Foundation during the conduct of the study. No other disclosures were reported. EDAT- 2024/02/21 12:42 MHDA- 2024/02/22 06:43 PMCR- 2024/02/21 CRDT- 2024/02/21 11:33 PHST- 2024/02/22 06:43 [medline] PHST- 2024/02/21 12:42 [pubmed] PHST- 2024/02/21 11:33 [entrez] PHST- 2024/02/21 00:00 [pmc-release] AID - 2815362 [pii] AID - zoi240001 [pii] AID - 10.1001/jamanetworkopen.2024.0001 [doi] PST - epublish SO - JAMA Netw Open. 2024 Feb 5;7(2):e240001. doi: 10.1001/jamanetworkopen.2024.0001.