Measuring DEI Awareness, Empowerment, and Action Orientation: Validation of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI)

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Jason Lynch, Amanda K. Burbage This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2653012/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Educating students in health occupations about the need to consider DEI in their practice can lead to improved health care outcomes for all populations. Measuring health professions educators’ awareness, empowerment, and action orientation toward diversity, equity, and inclusion (DEI) is one step toward addressing disparities in health care. In this article, thedevelopment and examination of the psychometric properties of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI) are described. Exploratory factor analysis was performed on data collected from health professions educators at seven higher education institutions in the United States. Factor analysis resulted in a three-factor structure measuring awareness, empowerment, and action orientation of health professions educators as they address issues of diversity, equity, and inclusion in their teaching. The resulting scale provides a nuanced way to explore the competencies necessary for effectively considering diversity, equity, and inclusion in health professions education. The HPE DEI is adaptable for educators across degree levels and academic disciplines. diversity equity inclusion DEI health professions education medical education scale validation Introduction This paper describes the development and validation of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI). Ongoing concerns about disparities in health care emphasize the importance of educating students in health occupations about the need to consider diversity, equity, and inclusion (DEI) in their practice to improve health care outcomes for all populations (Bouye et al., 2016; Jackson & Gracia, 2014). The development and validation of the HPE DEI scale contributes to theoretical understanding of the connection between knowledge and action and provides health professions institutions with a practical resource to gauge faculty awareness, empowerment, and action orientation towards DEI. Students in medical and health professions require education about structural issues like access to safe housing, clean water and healthy food, and the systemic bias in the health care system that are known to impact the health outcomes of people from historically excluded backgrounds (Ferrer, 2018; “Social Determinants of Health | CDC,” n.d.). Professional organizations in health professions education have emphasized a commitment to diversifying their professions as a means to address health inequities and foster a culture of DEI (Association of American Medical Colleges [AAMC], 2021; AAPA, 2021); however, diversity of medical education lags, with students who are low-income, racial and ethnic populations underrepresented in medical schools relative to their numbers in the general population. The advent of COVID-19 led to an increase in medical school applicants resulting in an increase in student diversity (AAMC, 2004, 2022a); however, faculty diversity in medical schools has not kept pace with the diversity of student populations (Teshome et al., 2022; Xierali et al., 2017). Medical students from historically excluded backgrounds find the lack of faculty with similar backgrounds to be a barrier to their medical school experience (Page et al., 2011; Teshome et al., 2022). Medical and health professions students with historically excluded identities often experience mistreatment and discrimination that leads to burnout (Teshome et al., 2022). These experiences are multiplied for students with intersecting identities, where students with multiple identities (e.g., sex, race, socioeconomic status, sexual orientation) experience the accumulated impact of those identities on their lived experiences (Bi et al., 2020; Crenshaw, 1989). Research has shown that faculty diversity impacts the success of students from historically excluded backgrounds resulting in improved retention, higher grades, and greater degree attainment (Curtis, 2021; Llamas et al., 2021; Stout et al., 2016). In addition, studying with a diverse student body enhances the educational experience of all students and leads to students working more effectively with people of different backgrounds (Park & Denson, 2013; Whitla et al., 2003). These are skills that are especially important for health care professionals as they work with an increasingly diverse population and highlights a need for health professions educators to consider the diverse backgrounds of their learners and the clinical populations they serve. The challenges of working with more culturally diverse populations have been recognized internationally by healthcare education systems (Ludwig et al., 2020; Mews et al., 2018; Napier et al., 2014), and cultural competence has been identified as a standard for medical and health professions students. Cultural competence training is considered essential to providing culturally responsive health care with the Association of American Medical Colleges (AAMC) developing tools that assist schools in assessing cultural competence in the curriculum (AAMC, 2022b); however, adoption of cultural competence training outside the US is less structured (Sorenson et al., 2019). Although cultural competence is considered essential, the concept is not well defined. One of the first descriptions focused on cultural competence through a systems lens defining it as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations.” (Cross et al., 1989, p. 28). Other definitions have included specific constructs related to cultural competence including knowledge, understanding, sensitivity, interactions, and skills (Burchum, 2002; Kim-Godwin et al. 2001), but cultural competence relies on ethnocentrism and emphasizes becoming an expert, or competent, in knowing other cultures without exploring the systems in place that lead to inequalities (Capell et al., 2008; Fisher-Borne, 2015). It has been criticized as not being an appropriate construct for health professions education because it does not account for structural forces and focuses primarily on knowledge acquisition (Fisher-Borne et al, 2015). Measurement of cultural capital is also a challenge, as many cultural competence scales have been developed; however, most of these scales lack evidence of application in practice and psychometric evaluation (Shen, 2015). Research related to DEI in health professions education has increased due to a commitment by health professions educators to understand the diverse populations served by health care professionals. For purposes of this study, we used the American Psychological Association’s (APA) definitions of diversity, equity, and inclusion. APA defines diversity as the representation of various social identity groups with a focus on social identities that correspond to societal power and privilege structures; equity requires provision of resources based on the need to help diverse populations “achieve their highest state of health and other functioning” (p.3), and inclusion requires “an environment that offers affirmation, celebration, and appreciation of different approaches, styles, perspectives, and experiences” (American Psychological Association’s Equity, Diversity, and Inclusion Office, 2021, p.14). Tools to evaluate bias in medical and health professions education course content have been developed (Caruso Brown et al., 2019) and training in DEI related concepts like implicit bias and cultural competence are commonly provided to health professions educators (Betancourt, 2006). However, there is a lack of validated tools to measure health professions educators’ awareness, empowerment, and action orientation related to DEI. This study aimed to develop and examine the psychometric properties of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI). The HPE DEI Scale was developed to go beyond evaluating cultural competence by measuring three DEI related constructs: awareness, empowerment, and action orientation. Messick’s validity framework was operationalized by asking what knowledge, skills, and other attributes should be assessed because of their connections to DEI in health professions education and what contexts should elicit those behaviors (Embretson, 2007; Messick, 1989). Thus, we considered the qualities of awareness, empowerment, and action orientation as reflected in the scale scores and if the constructs correlated with constructs in the environment that foster development of the DEI related traits (Whitely, 1983). The personal awareness construct examines personal familiarity and self-focus and functions on a continuum of low to high (Trevethan, 2017). Within health professions the terms “often refer to the general information and perceptions that people possess and exhibit, but specific reference is sometimes made to their own health and to healthcare providers’ knowledge and awareness” (Trevethan, 2017, p. 1). Knowledge and awareness are often connected in research with ongoing debates about the extent to which they are ontologically related (Littlejohn, 2015; Silva, 2019). Personal awareness is conceptually distinct from general awareness, general knowledge, and detailed specific knowledge. Health professions educators can use their personal awareness of how DEI intersects with teaching and patient care to communicate the importance of DEI awareness in creating inclusive learning environments and combatting health disparities. Empowerment includes self-efficacy, autonomy, and professional growth, which aligns with the person-focused notion of empowerment adopted for this study (Short, 1994). Educator empowerment is difficult to define across contexts and could include educator-focused aspects such as professional development, but also include structural aspects such as authority, leadership, and collaboration (Snodgrass Rangel et al, 2020). Empowered faculty “make use of their professional judgment and creativity,” a person-focused approach, rather than relying solely on guidelines or standards in medical and health professions education, a structural-approach (van Loon & Scheele, 2021, p.173). Empowering faculty by providing time and opportunity to consider DEI in their teaching can improve the learning environment (van Loon & Scheele, 2021) resulting in a learning environment where students feel represented, celebrated, and supported. Empowered faculty model behaviors that train health professions students to use professional judgment in their practice. Action orientation is the enactment of change-oriented intentions that arise as a result of encountering difficulties in pursuit of a goal (Koole & Jostmann, 2004; Kuhl, 1981). It is an important component in resolving action crisis, which occurs when an individual experiences conflict between their goals and alternative outcomes. Action orientation results in the ability to adapt and to experience personal growth when dealing with setbacks (Herrmann & Branstatter, 2013). Health professions educators require an action orientation to go beyond being subject matter experts in order to critically consider alternative solutions to address DEI in their learning environment. In sum, action orientation determines the educator’s decision to act on DEI-focused teaching and care practices. By enacting a DEI focused action orientation, educators can model behavior that their students can use in their learning and clinical practice. Development Of The Hpe Dei Scale Phillips et al ( 2021 ) six-step approach to scale development was used. The first step, needs-assessment, began with an extensive literature search for an existing scale. Searching terms “diversity”, “equity”, “inclusion”, “cultural competence”, “cultural humility”, “health professions”, and “education”, 16 potential scales were identified. Scales were grouped into three categories: describing understanding of practitioners, assessing training needs for practitioners, and investigating practices in specific contexts. Although portions of various validated scales were applicable to this study, we found no scale which measured constructs of awareness and knowledge with an action orientation. Social cognitive theory (Bandura, 1986 ) explains that behavioral capability is based on essential knowledge, and people seek personal empowerment in their environments. In learning environments realistic practice and feedback systems forge connections between knowledge and action (Arlinghaus & Johnston, 2018; Hauer et al, 2012 ). Therefore, the development of a new scale began with an extensive literature search and discussions with experts in the DEI field, adopting the APA’s definitions for DEI for use in the development of a new scale. In total, 19 items were developed and intended to be measured using a 5-point Likert scale with 1 indicating strong disagreement and 5 indicating strong agreement. Of the items, six were worded negatively and 13 were worded positively in order to mitigate potential acquiescence bias. See Table 1 for a complete blueprint of the HPE DEI scale. Table 1 Blueprint for the Health Professions Educator Diversity Equity & Inclusion (HPE DEI) Scale Item Self-Awareness & Beliefs Environmental Awareness & Context Self-Efficacy for Action 1 + I am aware of my own biases or judgements I hold toward others and social groups different from my own. x 2 + I am aware of how my background and experiences shape how I view others and social groups different from my own. x 3 - My attitudes and beliefs have no impact on my interactions with others and social groups different from my own. x 4 + Differences between people and social groups are a positive thing. x 5 - My privileges have little impact on my ability to be an effective medical and health professions educator. x 6 + People's life experiences shape their perceptions of the world around them x 7 + My perceptions of the world have shaped my ability to be an effective medical and health professions educator. x 8 + I am knowledgeable of equity and inclusion issues impacting medical and health professions education. x 9 + I am aware of best practices and resources to advance equity and inclusion within medical and health professions education. x 10 - Exploring issues of equity and inclusion should not be a high priority for medical and health professions education. x 11 - Bias against specific groups of people plays little role in social determinants of health. x 12 + I am aware of equity and inclusion efforts at my current institution. x 13 + I actively seek out resources, training, or developmental opportunities to learn more about issues of equity and inclusion. x 14 + I am confident in my ability to effect change regarding equity and inclusion in medical and health professions education. x 15 + I am comfortable integrating topics on equity and inclusion when engaged in teaching or training. x 16 - I lack the tools to directly address issues of equity and inclusion within my sphere of influence in medical and health professions education. x 17 - I am unsure how I can use my privileges to combat inequities in medical and health professions education. x 18 + I want to be a source of positive change regarding equity and inclusion in medical and health professions education. x 19 + I am comfortable engaging in potentially hard conversations regarding issues of equity and inclusion. x Note. +/- used to indicate positive or negative wording of item within the scale Validation Methods Before the HPE DEI scale was piloted, a small panel of subject matter experts (SMEs) were recruited to comment on the face validity of the instrument determining if items were representative of the construct of interest. SMEs included faculty with expertise in scale development, chief diversity officers in postsecondary education, and faculty working within health professions education. Four items were altered to improve clarity based on a consensus of feedback, as well as the inclusion of the chosen definition of diversity, equity, & inclusion (APA’s Equity, Diversity, and Inclusion Office, 2021). Pilot distribution of the HPE DEI scale took place during the Spring 2022 semester across health professions programs within seven institutions of higher education, approved by the institutional review board. Programs included nursing, medicine, public health, health professions education, and medical simulations. Institutions represented public and private four-year schools, as well as two-year community colleges. A purposeful sample of health professions educators was utilized. Participants were invited to complete the HPE DEI scale electronically via emails sent to directors of health professions education programs encouraging them to forward the invitation to their faculty and students. Snowball sampling was employed, as the recruitment message encouraged participants to forward the invitation to peers who may be interested in participating. A total of 68 educators completed the survey, which was deemed sufficient for analysis (Winter et al, 2009 ). See Table 2 for demographic information. Table 2 Summary of Sample Demographics N % N % Race Age White 50 68.5 25–30 3 4.4 Asian or Asian American 8 11.0 31–36 9 13.2 Prefer not to respond 5 6.8 37–42 13 19.1 Native Hawiian or Pacific Islander 3 4.1 43–48 11 16.2 Other 3 4.1 49–54 11 16.2 Native American or American Indian 2 2.7 55+ 21 30.9 Black or African American 2 2.7 Gender Self-Reported Professional DE&I Training Women 46 67.6 None 2 2.9 Men 20 29.4 A little 29 42.6 Trans* 1 1.5 A moderate amount 23 33.8 Prefer not to respond 1 1.5 A lot 9 13.2 A great deal 4 5.9 Construct validity of the HPE DEI scale was analyzed using pilot data. First, exploratory factor analysis (EFA) was used to investigate the underlying factor structure of the 19-item instrument. Direct Oblimin rotation was applied to the EFA given the anticipated factors corresponding to the three hypothesized constructs (DeVellis, 2011 ). We then selected a Maximum Likelihood Analysis to condense the instrument into a series of linear uncorrelated components (Costello & Osborne, 2005 ). Upon completion of the EFA, we used Chronbach’s alpha to determine internal consistency among items for both the HPE DEI scale, as well as sub-scales determined from EFA results. All quantitative data were analyzed using SPSS Statistical Software Version 27. Results Initial results of exploratory factor analysis (EFA) uncovered a four-factor structure (Table 3 ). We used multiple criteria when determining the number of factors and items to retain. Factor retention was determined using the criterion of eigenvalue greater than 1.00. Item retention was determined using items that produced communalities rounding to 0.40 or above (DeVellis, 2011 ) and factor weights above .30. Items not meeting this criteria were removed. Additionally Factor 2 was removed as it contained less than three items (DeVellis, 2011 ; Henson & Roberts, 2006 ). Taking these restrictions into consideration, the final model resulted in a 13 item scale across three factors. Based on a thematic analysis, Factor 1 was labeled as ‘Awareness’, Factor 3 was labeled as ‘Empowerment’, and Factor 4 was labeled as ‘Action Orientation.’ Additionally, all subscales resulted in satisfactory alpha levels (Ursachi et al., 2015 ) between .61 and .84, with the overall instrument reflecting an alpha of .80. Table 3 Results of HPE DEI Exploratory Factor Analysis Item Factor 1 Factor 2 Factor 3 Factor 4 HPE DEI Scale Communalities 1 People's life experiences shape their perceptions of the world around them. 0.89 0.81 2 My perceptions of the world have shaped my ability to be an effective health professions educator. 0.80 0.57 3 I am aware of how my background and experiences shape how I view others and social groups different from my own. 0.64 0.50 4 I am aware of my own biases or judgements that I hold toward others and toward social groups different from my own. 0.61 0.51 5 Differences between people and social groups are a positive thing. 0.53 0.47 6 I am knowledgeable of equity and inclusion issues impacting health professions education. 0.47 0.50 7 I am comfortable engaging in potentially hard conversations regarding issues of equity and inclusion.* 0.39 0.24 8 I am aware of equity and inclusion efforts at my current institution.* 0.38 0.34 9 My privileges have little impact on my ability to be an effective health professions educator.* 0.89 0.80 10 My attitudes and beliefs have no impact on my interactions with others and social groups different from my own.* 0.68 0.46 11 I am aware of best practices and resources to advance equity and inclusion within health professions education 0.61 0.59 12 I am confident in my ability to effect change regarding equity and inclusion in HPE. 0.39 0.52 13 I lack the tools to directly address issues of equity and inclusion within my sphere of influence in HPE. -0.56 0.36 14 I am unsure how I can use my privileges to combat inequities in HPE. -0.83 0.67 15 Exploring issues of equity and inclusion should not be a high priority for health professions education. 0.70 0.50 16 Bias against specific groups of people plays little role in social determinants of health.* 0.54 0.29 17 I am comfortable integrating topics on equity and inclusion when engaged in teaching or training. -0.34 0.40 18 I actively seek out resources, training, or developmental opportunities to learn more about issues of equity and inclusion.* -0.37 0.30 19 I want to be a source of positive change regarding equity and inclusion in health professions education. -0.74 0.79 Eigenvalue 5.65 2.30 2.02 1.42 % variance explained 29.72 12.08 10.64 7.49 59.93 Chronbach’s ∝ 0.85 0.71 0.61 0.80 Note. * indicates item removed from scale and subscale. Descriptive statistics from the HPE DEI scale can be found in Table 4 . Data indicated that participants scored, on average, higher across the Awareness (Factor 1, M = 4.45) and Action Orientation (Factor 4, M = 4.25) subscales, while scoring relatively lower across the Empowerment (Factor 3, M = 3.41) subscale. These results indicate that health professions educators may perceive themselves as aware of DEI topics and willing to engage in the work needed to make a change, but may lack the resources, skill, or confidence in taking action to address DEI issues. Additionally, while items “My attitudes and beliefs have no impact on my interactions with others and social groups different from my own” and “My privileges have little impact on my ability to be an effective health professions educator” were not included in the final scale, participants scored relatively low ( M = 2.63 and M = 3.26 respectively) indicating that a significant number of participants do not believe that their privilege and beliefs impact their effectiveness as educators. Table 4 HPE DEI Scale Descriptive Statistics Mean Median SD Factor 1 4.45 4.5 0.54 Factor 3 3.41 3.38 0.82 Factor 4 4.25 4.67 0.80 HPE DEI Scale 4.08 4.08 0.52 I am aware of my own biases or judgements that I hold toward others and toward social groups different from my own. 4.29 4.00 0.71 I am aware of how my background and experiences shape how I view others and social groups different from my own. 4.49 5.00 0.70 My attitudes and beliefs have no impact on my interactions with others and social groups different from my own. 2.63 2.00 1.40 Differences between people and social groups are a positive thing. 4.60 5.00 0.78 My privileges have little impact on my ability to be an effective health professions educator. 3.26 3.00 1.24 People's life experiences shape their perceptions of the world around them. 4.75 5.00 0.61 My perceptions of the world have shaped my ability to be an effective health professions educator. 4.31 4.00 0.83 I am knowledgeable of equity and inclusion issues impacting health professions education. 4.25 4.00 0.76 I am aware of best practices and resources to advance equity and inclusion within health professions education. 3.62 4.00 0.99 Exploring issues of equity and inclusion should not be a high priority for health professions education. 1.82 1.00 1.30 Bias against specific groups of people plays little role in social determinants of health. 1.79 1.00 1.37 I am aware of equity and inclusion efforts at my current institution. 4.10 4.00 1.00 I actively seek out resources, training, or developmental opportunities to learn more about issues of equity and inclusion. 3.65 4.00 1.21 I am confident in my ability to effect change regarding equity and inclusion in health professions education. 3.57 4.00 1.01 I am comfortable integrating topics on equity and inclusion when engaged in teaching or training. 4.04 4.00 0.97 I lack the tools to directly address issues of equity and inclusion within my sphere of influence in health professions education. 2.72 3.00 1.27 I am unsure how I can use my privileges to combat inequities in health professions education. 2.84 3.00 1.21 I want to be a source of positive change regarding equity and inclusion in health professions education. 4.53 5.00 0.91 I am comfortable engaging in potentially hard conversations regarding issues of equity and inclusion. 4.25 4.00 0.92 Discussion Factor analysis of the HPE DEI scale resulted in a three-factor structure measuring awareness, empowerment, and action orientation of health professions educators as they address issues of diversity, equity, and inclusion in their teaching. While the sample of this scale validation scored high in awareness and action orientation, the relatively low scores on empowerment indicate that there is more work to be done to foster empowerment to act. Health professions educators’ personal familiarity and self-focus, or awareness of DEI in their teaching coupled with empowerment through self-efficacy, autonomy, and professional growth can lead to action orientation and the enactment of change-oriented intentions. However, the results of this study demonstrate that empowerment, which is a catalyst for action, is a barrier. Health professions education professional organizations have shown a commitment to considering DEI in healthcare education to address health inequities (AAMC, 2021; AAPA, 2021 ); however, these results indicate that more resources are needed to support the efforts of educators. Health professions educators are stretched thin with many managing multiple clinical and academic priorities experiencing stress and burnout (Çelmeçe & Menekay, 2020 ; Lyndon, 2016 ). Requiring additional DEI training only adds to an already taxing workload, and courses which target the knowledge-domain alone are insufficient to create behavior change (Arlinghaus & Johnston, 2018). Instead, health professions education institutions need to operationalize the commitment to DEI with resources for implementation. For instance, professional development targeting connections between awareness and empowerment, using action-oriented and authentic practice with personalized feedback (Hauer et al, 2012 ) may increase faculty beliefs that they are capable of addressing DEI along other subject matter expertise. Further, institutions should provide material support such as course releases and support staff for administering DEI-assessment tools like the Upstate Bias Checklist (Caruso Brown et al. 2019 ). Although factor 2, relating to educators’ privilege and DEI, was removed due to the low number of items within the factor, health professions education leaders looking to emphasize the importance of considering DEI within their curriculum should be concerned that a significant number of participants indicated agreement that their privileges and/or beliefs have little to do with their effectiveness as an educator or impact on social groups. Future research should explore how privilege impacts health professions educators’ beliefs about who should take action related to DEI issues. Such attitudes may prove to be a barrier to change as some health professions educators may adopt the attitude that the lack of DEI considerations in the curriculum is not their problem. The HPE DEI Scale provides a reliable measure that goes beyond the limitations of considering cultural knowledge and sensitivity toward multiple cultures by evaluating educators’ awareness, empowerment, and action orientation related to DEI in the educational and health care context. This scale provides a more nuanced way to explore the competencies necessary for effectively considering DEI in teaching. The work of building DEI into course content requires consideration beyond culture including the systems in place that impact historically excluded populations’ access to education and health care. The HPE DEI Scale can be used to measure changes in faculty awareness, empowerment, and action orientation as they actively engage in building DEI into their coursework and can lead to evaluation of the resources needed to empower faculty to engage in the process on an ongoing basis. Limitations And Conclusion This study is limited by a small sample of mostly white, female health professions educators. All data was self-reported therefore responses may have been impacted by acquiescence bias. A replication study with a more demographically diverse faculty sample may provide more insights. Social consequences of the scale’s use should be considered (Messick, 1995 ) due to the current politicization of “divisive issues” in education where inclusion of DEI in the curriculum is seen as a threat to the status quo (McMutrie, 2021). Educators may fear social and political retribution as a result of completing the HPE DEI scale. Future research should seek to test criterion validity of the instrument by investigating associations between instructors’ HPE DEI Scale scores and student-feedback on course evaluations regarding DEI. This is particularly important to explore in relation to feedback of students from marginalized or excluded groups. Additional research should explore relationships between instructors’ HPE DEI scores and level of DEI training as well. Further work with a sample of faculty in other health professions education fields and in other educational contexts will help strengthen the validity of the instrument. Future work might include a larger sample of participants to conduct measurement invariance analyses across groups such as gender, race, field of study, or level of DEI training. In addition, item modification to suit other types of educators can determine validity beyond health professions education. Disparities in health care can begin to be addressed by educating students in health occupations about the need to consider DEI in their practice leading to improved health care outcomes for all populations (Bouye et al., 2016 ; Jackson & Gracia, 2014 ). Medical education content has been found to include race, ethnicity, gender and other characteristic-related bias (Caruso Brown et al. 2019 ). This bias can lead to health professionals and health professions students holding false beliefs about biological differences between races with race often presented in the educational context as a biological risk factor (Hoffman et al. 2016 ; Tsai et al. 2016 ). The misinformation is just one example of how existing educational structures contribute to disparities in treatment, and how aware, empowered, and action-oriented educators can disabuse students of biased health-related notions. While health professions education professional organizations have emphasized a commitment to diversifying their professions and addressing health inequities while fostering a culture of DEI, it is important to develop a plan to measure progress. The HPE DEI scale is a tool that can be used to evaluate health professions educators’ awareness, empowerment, and action orientation as they engage in teaching and learning about DEI and can be adapted by educators outside the US and in other professions. Health professions educators are training future health professionals, therefore their attitudes about building DEI into their course content can lead to increased awareness, empowerment, and action orientation in the students they teach. Declarations Contributions All authors were involved in conceiving the study and reviewing the manuscript. Author 1 substantially contributed to the literature review and discussion. Author 2 substantially contributed to methods and results, and Author 3 substantially contributed to literature review and editing. Acknowledgements None Conflicts of Interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Funding No funding was received to assist with the conducting of this study nor preparation of this manuscript. Ethics The questionnaire and methodology for this study was approved by the Author 1’s IRB. Consent to Participate Informed consent was obtained from all individual participants included in the study. Data Availability The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. References American Association of Medical Colleges (2021). Diversity & Inclusion. Association of American Medical Colleges. Retrieved from https://www.aamc.org/what-we-do/diversity-inclusion American Association of Medical Colleges (2022a, December 13). Diversity Increases at Medical Schools in 2022). https://www.aamc.org/news-insights/press-releases/diversity-increases-medical-schools-2022 American Association of Medical Colleges (2022b, October, 28). Tool for Assessing Cultural Competence Training (TACCT). https://www.aamc.org/what-we-do/equity-diversity-inclusion/tool-for-assessing-cultural-competence-training AAPA (2021). 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P., Hill, K. A., Li, F., Samuels, E. A., Wong, A. H., Xu, Y., & Boatright, D. H. (2022). Marginalized identities, mistreatment, discrimination, and burnout among US medical students: Cross sectional survey and retrospective cohort study. BMF , 376 (e065984), http://doi.org/10.1136/bmj-2021-065984 . Trevethan, R. (2017). Deconstructing and assessing knowledge and awareness in public health research. Frontiers in Public Health , 5 , 194. http://doi.org/10.3389/fpubh.2017.00194 . Tsai, J., Ucik, L., Baldwin, N., Hasslinger, C., & George, P. (2016). Race matters? Examining and rethinking race portrayal in preclinical medical education. Academic Medicine , 91 (7), 916–920. http://doi.org/10.1097/ACM.0000000000001232 . Ursachi, G., Horodnic, I. A., & Zait, A. (2015). How reliable are measurement scales? External factors with indirect influence on reliability estimators. Procedia Economics and Finance, 20 (2015), 679–686. http://doi.org/10.1016/S2212-5671(15)00123-9 van Loon, K. A., & Scheele, F. (2021). Improving graduate medical education through faculty empowerment instead of detailed guidelines. Academic Medicine , 96 (2), 173–175. http://doi.org/10.1097/ACM.0000000000003386 . Whitla, D. K., Orfield, G., Silen, W., Teperow, C., Howard, C., & Reede, J. (2003). Educational benefits of diversity in medical school: a survey of students. Academic Medicine , 78 (5), 460–466. http://doi.org/10.1097/00001888-200305000-00007 . Whitely, S. E. (1983). Construct validity: Construct representation versus nomothetic span. Psychological bulletin , 93 (1), 179. https://doi.org/10.1037/0033-2909.93.1.179 . Winter, J. C., Dodou, D., & Wieringa, P. A. (2009). Exploratory factor analysis with small sample sizes. Multivariate Behavioral Research , 44 (2), 147–181. http://doi.org/10.1080/00273170902794206 . Xierali, I. M., Nivet, M. A., Gaglioti, A. H., Liaw, W. R., & Bazemore, A. W. (2017). Increasing family medicine faculty diversity still lags population trends. The Journal of the American Board of Family Medicine , 30 (1), 100–103. https://doi.org/10.3122/jabfm.2017.01.160211 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2653012","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":180750130,"identity":"35b0b545-71df-4364-8fa1-39d076b001c5","order_by":0,"name":"Peggy Gesing","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYJCCAyCCH8phbCBai2QDKVrAwOAAsVrk3dsfHi74tU3O+HiP6cYfDDayGw4Q0GJ45ozB4Zl9t43Nzpwxu83DkGZMWMuMHIbDvD23E7fdSEu7zcBwOJGwlvnPH4C01G+e/yzt5g+G/4S1yEswGBzm+XE7wUCC+dgNHoYDhLUY8OQYHOZtuG0440zysds8BsnGMwna0n788WeeP7fl+dsPtt38UWEn20fQFpACxjY4l4BysC0NIPIPESpHwSgYBaNg5AIABohNqx1RG9kAAAAASUVORK5CYII=","orcid":"","institution":"Eastern Virginia Medical School","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Peggy","middleName":"","lastName":"Gesing","suffix":""},{"id":180750131,"identity":"455ade2b-85f3-4b4f-bcef-dbc8a684211b","order_by":1,"name":"R. Jason Lynch","email":"","orcid":"","institution":"Appalachian State University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"R.","middleName":"Jason","lastName":"Lynch","suffix":""},{"id":180750132,"identity":"5f85875c-e0bb-440f-9685-635bdd60a729","order_by":2,"name":"Amanda K. Burbage","email":"","orcid":"","institution":"Eastern Virginia Medical School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amanda","middleName":"K.","lastName":"Burbage","suffix":""}],"badges":[],"createdAt":"2023-03-03 20:14:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2653012/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2653012/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":39752641,"identity":"1a522161-bea4-4e0b-83ff-29ac202fded4","added_by":"auto","created_at":"2023-07-09 14:29:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":315808,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2653012/v1/8fd1dddf-50ab-458b-b20c-6a61a55c7648.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Measuring DEI Awareness, Empowerment, and Action Orientation: Validation of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThis paper describes the development and validation of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI).\u0026nbsp;Ongoing concerns about disparities in health care emphasize the importance of educating students in health occupations about the need to consider diversity, equity, and inclusion (DEI) in their practice to improve health care outcomes for all populations (Bouye et al., 2016; Jackson \u0026amp; Gracia, 2014). The development and validation of the HPE DEI scale contributes to theoretical understanding of the connection between knowledge and action and provides health professions institutions with a practical resource to gauge faculty awareness, empowerment, and action orientation towards DEI.\u003c/p\u003e\n\u003cp\u003eStudents in medical and health professions require education about structural issues like access to safe housing, clean water and healthy food, and the systemic bias in the health care system that are known to impact the health outcomes of people from historically excluded backgrounds (Ferrer, 2018; \u0026ldquo;Social Determinants of Health | CDC,\u0026rdquo; n.d.). Professional organizations in health professions education have emphasized a commitment to diversifying their professions as a means to address health inequities and foster a culture of DEI (Association of American Medical Colleges [AAMC], 2021; AAPA, \u0026nbsp; 2021); however, diversity of medical education lags, with students who are low-income, racial and ethnic populations underrepresented in medical schools relative to their numbers in the general population. The advent of COVID-19 led to an increase in medical school applicants resulting in an increase in student diversity (AAMC, 2004, 2022a); however, faculty diversity in medical schools has not kept pace with the diversity of student populations (Teshome et al., 2022; Xierali et al., 2017). Medical students from historically excluded backgrounds find the lack of faculty with similar backgrounds to be a barrier to their medical school experience (Page et al., 2011; Teshome et al., 2022). Medical and health professions students with historically excluded identities often experience mistreatment and discrimination that leads to burnout (Teshome et al., 2022). These experiences are multiplied for students with intersecting identities, where students with multiple identities (e.g., sex, race, socioeconomic status, sexual orientation) experience the accumulated impact of those identities on their lived experiences (Bi et al., 2020; Crenshaw, 1989). Research has shown that faculty diversity impacts the success of students from historically excluded backgrounds resulting in improved retention, higher grades, and greater degree attainment (Curtis, 2021; Llamas et al., 2021; Stout et al., 2016). In addition, studying with a diverse student body enhances the educational experience of all students and leads to students working more effectively with people of different backgrounds (Park \u0026amp; Denson, 2013; Whitla et al., 2003). These are skills that are especially important for health care professionals as they work with an increasingly diverse population and highlights a need for health professions educators to consider the diverse backgrounds of their learners and the clinical populations they serve.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe challenges of working with more culturally diverse populations have been recognized internationally by healthcare education systems (Ludwig et al., 2020; Mews et al., 2018; Napier et al., 2014), and cultural competence has been identified as a standard for medical and health professions students. Cultural competence training is considered essential to providing culturally responsive health care with the Association of American Medical Colleges (AAMC) developing tools that assist schools in assessing cultural competence in the curriculum (AAMC, 2022b); however, adoption of cultural competence training outside the US is less structured (Sorenson et al., 2019). Although cultural competence is considered essential, the concept is not well defined. One of the first descriptions focused on cultural competence through a systems lens defining it as \u0026ldquo;a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations.\u0026rdquo; (Cross et al., 1989, p. 28). Other definitions have included specific constructs related to cultural competence including knowledge, understanding, sensitivity, interactions, and skills (Burchum, 2002; Kim-Godwin et al. 2001), but cultural competence relies on ethnocentrism and emphasizes becoming an expert, or competent, in knowing other cultures without exploring the systems in place that lead to inequalities (Capell et al., 2008; Fisher-Borne, 2015). It has been criticized as not being an appropriate construct for health professions education because it does not account for structural forces and focuses primarily on knowledge acquisition (Fisher-Borne et al, 2015). Measurement of cultural capital is also a challenge, as many\u0026nbsp;cultural competence scales have been developed; however, most of these scales lack evidence of application in practice and psychometric evaluation (Shen, 2015).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResearch related to DEI in health professions education has increased due to a commitment by health professions educators to understand the diverse populations served by health care professionals. For purposes of this study, we used the American Psychological Association\u0026rsquo;s (APA) definitions of diversity, equity, and inclusion. APA defines diversity as the representation of various social identity groups with a focus on social identities that correspond to societal power and privilege structures; equity requires provision of resources based on the need to help diverse populations \u0026ldquo;achieve their highest state of health and other functioning\u0026rdquo; (p.3), and inclusion requires \u0026ldquo;an environment that offers affirmation, celebration, and appreciation of different approaches, styles, perspectives, and experiences\u0026rdquo; (American Psychological Association\u0026rsquo;s Equity, Diversity, and Inclusion Office, 2021, p.14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTools to evaluate bias in medical and health professions education course content have been developed (Caruso Brown et al., 2019) and training in DEI related concepts like implicit bias and cultural competence are commonly provided to health professions educators (Betancourt, 2006). However, there is a lack of validated tools to measure health professions educators\u0026rsquo; awareness, empowerment, and action orientation related to DEI. \u0026nbsp;This study aimed to develop and examine the psychometric properties of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe HPE DEI Scale was developed to go beyond evaluating cultural competence by measuring three DEI related constructs: awareness, empowerment, and action orientation.\u0026nbsp;Messick\u0026rsquo;s validity framework was operationalized by asking what knowledge, skills, and other attributes should be assessed because of their connections to DEI in health professions education and what contexts should elicit those behaviors (Embretson, 2007; Messick, 1989). Thus, we considered the qualities of awareness, empowerment, and action orientation as reflected in the scale scores and if the constructs correlated with constructs in the environment that foster development of the DEI related traits (Whitely, 1983).\u003c/p\u003e\n\u003cp\u003eThe personal awareness construct examines personal familiarity and self-focus and functions on a continuum of low to high (Trevethan, 2017). Within health professions the terms \u0026ldquo;often refer to the general information and perceptions that people possess and exhibit, but specific reference is sometimes made to their own health and to healthcare providers\u0026rsquo; knowledge and awareness\u0026rdquo; (Trevethan, 2017, p. 1). Knowledge and awareness are often connected in research with ongoing debates about the extent to which they are ontologically related (Littlejohn, 2015; Silva, 2019). \u0026nbsp;Personal awareness is conceptually distinct from general awareness, general knowledge, and detailed specific knowledge. Health professions educators can use their personal awareness of how DEI intersects with teaching and patient care to communicate the importance of DEI awareness in creating inclusive learning environments and combatting health disparities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEmpowerment includes self-efficacy, autonomy, and professional growth, which aligns with the person-focused notion of empowerment adopted for this study (Short, 1994). Educator empowerment is difficult to define across contexts and could include educator-focused aspects such as professional development, but also include structural aspects such as authority, leadership, and collaboration (Snodgrass Rangel et al, 2020). Empowered faculty \u0026ldquo;make use of their professional judgment and creativity,\u0026rdquo; a person-focused approach, rather than relying solely on guidelines or standards in medical and health professions education, a structural-approach (van Loon \u0026amp; Scheele, 2021, p.173). Empowering faculty by providing time and opportunity to consider DEI in their teaching can improve the learning environment (van Loon \u0026amp; Scheele, 2021) resulting in a learning environment where students feel represented, celebrated, and supported. Empowered faculty model behaviors that train health professions students to use professional judgment in their practice.\u003c/p\u003e\n\u003cp\u003eAction orientation is the enactment of change-oriented intentions that arise as a result of encountering difficulties in pursuit of a goal (Koole \u0026amp; Jostmann, 2004; Kuhl, 1981). \u0026nbsp;It is an important component in resolving action crisis, which occurs when an individual experiences conflict between their goals and alternative outcomes. Action orientation results in the ability to adapt and to experience personal growth when dealing with setbacks (Herrmann \u0026amp; Branstatter, 2013). Health professions educators require an action orientation to go beyond being subject matter experts in order to critically consider alternative solutions to address DEI in their learning environment. In sum, action orientation determines the educator\u0026rsquo;s decision to act on DEI-focused teaching and care practices. By enacting a DEI focused action orientation, educators can model behavior that their students can use in their learning and clinical practice.\u0026nbsp;\u003c/p\u003e"},{"header":"Development Of The Hpe Dei Scale","content":"\u003cp\u003ePhillips et al (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) six-step approach to scale development was used. The first step, needs-assessment, began with an extensive literature search for an existing scale. Searching terms \u0026ldquo;diversity\u0026rdquo;, \u0026ldquo;equity\u0026rdquo;, \u0026ldquo;inclusion\u0026rdquo;, \u0026ldquo;cultural competence\u0026rdquo;, \u0026ldquo;cultural humility\u0026rdquo;, \u0026ldquo;health professions\u0026rdquo;, and \u0026ldquo;education\u0026rdquo;, 16 potential scales were identified. Scales were grouped into three categories: describing understanding of practitioners, assessing training needs for practitioners, and investigating practices in specific contexts. Although portions of various validated scales were applicable to this study, we found no scale which measured constructs of awareness and knowledge with an action orientation.\u003c/p\u003e \u003cp\u003eSocial cognitive theory (Bandura, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1986\u003c/span\u003e) explains that behavioral capability is based on essential knowledge, and people seek personal empowerment in their environments. In learning environments realistic practice and feedback systems forge connections between knowledge and action (Arlinghaus \u0026amp; Johnston, 2018; Hauer et al, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Therefore, the development of a new scale began with an extensive literature search and discussions with experts in the DEI field, adopting the APA\u0026rsquo;s definitions for DEI for use in the development of a new scale.\u003c/p\u003e \u003cp\u003eIn total, 19 items were developed and intended to be measured using a 5-point Likert scale with 1 indicating strong disagreement and 5 indicating strong agreement. Of the items, six were worded negatively and 13 were worded positively in order to mitigate potential acquiescence bias. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for a complete blueprint of the HPE DEI scale.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eBlueprint for the Health Professions Educator Diversity Equity \u0026amp; Inclusion (HPE DEI) Scale\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSelf-Awareness \u0026amp; Beliefs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEnvironmental Awareness \u0026amp; Context\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSelf-Efficacy for Action\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am aware of my own biases or judgements I hold toward others and social groups different from my own.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am aware of how my background and experiences shape how I view others and social groups different from my own.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMy attitudes and beliefs have no impact on my interactions with others and social groups different from my own.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDifferences between people and social groups are a positive thing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMy privileges have little impact on my ability to be an effective medical and health professions educator.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePeople's life experiences shape their perceptions of the world around them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMy perceptions of the world have shaped my ability to be an effective medical and health professions educator.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am knowledgeable of equity and inclusion issues impacting medical and health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am aware of best practices and resources to advance equity and inclusion within medical and health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExploring issues of equity and inclusion should not be a high priority for medical and health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBias against specific groups of people plays little role in social determinants of health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am aware of equity and inclusion efforts at my current institution.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI actively seek out resources, training, or developmental opportunities to learn more about issues of equity and inclusion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am confident in my ability to effect change regarding equity and inclusion in medical and health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am comfortable integrating topics on equity and inclusion when engaged in teaching or training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI lack the tools to directly address issues of equity and inclusion within my sphere of influence in medical and health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am unsure how I can use my privileges to combat inequities in medical and health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI want to be a source of positive change regarding equity and inclusion in medical and health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am comfortable engaging in potentially hard conversations regarding issues of equity and inclusion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote.\u003c/em\u003e +/- used to indicate positive or negative wording of item within the scale\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Validation Methods","content":"\u003cp\u003eBefore the HPE DEI scale was piloted, a small panel of subject matter experts (SMEs) were recruited to comment on the face validity of the instrument determining if items were representative of the construct of interest. SMEs included faculty with expertise in scale development, chief diversity officers in postsecondary education, and faculty working within health professions education. Four items were altered to improve clarity based on a consensus of feedback, as well as the inclusion of the chosen definition of diversity, equity, \u0026amp; inclusion (APA\u0026rsquo;s Equity, Diversity, and Inclusion Office, 2021).\u003c/p\u003e \u003cp\u003e Pilot distribution of the HPE DEI scale took place during the Spring 2022 semester across health professions programs within seven institutions of higher education, approved by the institutional review board. Programs included nursing, medicine, public health, health professions education, and medical simulations. Institutions represented public and private four-year schools, as well as two-year community colleges.\u003c/p\u003e \u003cp\u003eA purposeful sample of health professions educators was utilized. Participants were invited to complete the HPE DEI scale electronically via emails sent to directors of health professions education programs encouraging them to forward the invitation to their faculty and students. Snowball sampling was employed, as the recruitment message encouraged participants to forward the invitation to peers who may be interested in participating. A total of 68 educators completed the survey, which was deemed sufficient for analysis (Winter et al, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for demographic information.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eSummary of Sample Demographics\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eRace\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eAge\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian or Asian American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to respond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37\u0026ndash;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative Hawiian or Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43\u0026ndash;48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative American or American Indian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack or African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGender\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003eSelf-Reported Professional DE\u0026amp;I Training\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrans*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA moderate amount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to respond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA great deal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eConstruct validity of the HPE DEI scale was analyzed using pilot data. First, exploratory factor analysis (EFA) was used to investigate the underlying factor structure of the 19-item instrument. Direct Oblimin rotation was applied to the EFA given the anticipated factors corresponding to the three hypothesized constructs (DeVellis, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). We then selected a Maximum Likelihood Analysis to condense the instrument into a series of linear uncorrelated components (Costello \u0026amp; Osborne, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUpon completion of the EFA, we used Chronbach\u0026rsquo;s alpha to determine internal consistency among items for both the HPE DEI scale, as well as sub-scales determined from EFA results. All quantitative data were analyzed using SPSS Statistical Software Version 27.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eInitial results of exploratory factor analysis (EFA) uncovered a four-factor structure (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). We used multiple criteria when determining the number of factors and items to retain. Factor retention was determined using the criterion of eigenvalue greater than 1.00. Item retention was determined using items that produced communalities rounding to 0.40 or above (DeVellis, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) and factor weights above .30. Items not meeting this criteria were removed. Additionally Factor 2 was removed as it contained less than three items (DeVellis, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Henson \u0026amp; Roberts, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Taking these restrictions into consideration, the final model resulted in a 13 item scale across three factors. Based on a thematic analysis, Factor 1 was labeled as \u0026lsquo;Awareness\u0026rsquo;, Factor 3 was labeled as \u0026lsquo;Empowerment\u0026rsquo;, and Factor 4 was labeled as \u0026lsquo;Action Orientation.\u0026rsquo; Additionally, all subscales resulted in satisfactory alpha levels (Ursachi et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) between .61 and .84, with the overall instrument reflecting an alpha of .80.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eResults of HPE DEI Exploratory Factor Analysis\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFactor 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFactor 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHPE DEI Scale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCommunalities\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeople's life experiences shape their perceptions of the world around them.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMy perceptions of the world have shaped my ability to be an effective health professions educator.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am aware of how my background and experiences shape how I view others and social groups different from my own.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am aware of my own biases or judgements that I hold toward others and toward social groups different from my own.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDifferences between people and social groups are a positive thing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am knowledgeable of equity and inclusion issues impacting health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am comfortable engaging in potentially hard conversations regarding issues of equity and inclusion.*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am aware of equity and inclusion efforts at my current institution.*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMy privileges have little impact on my ability to be an effective health professions educator.*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMy attitudes and beliefs have no impact on my interactions with others and social groups different from my own.*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eI am aware of best practices and resources to advance equity and inclusion within health professions education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eI am confident in my ability to effect change regarding equity and inclusion in HPE.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eI lack the tools to directly address issues of equity and inclusion within my sphere of influence in HPE.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eI am unsure how I can use my privileges to combat inequities in HPE.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eExploring issues of equity and inclusion should not be a high priority for health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eBias against specific groups of people plays little role in social determinants of health.*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eI am comfortable integrating topics on equity and inclusion when engaged in teaching or training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eI actively seek out resources, training, or developmental opportunities to learn more about issues of equity and inclusion.*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eI want to be a source of positive change regarding equity and inclusion in health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEigenvalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% variance explained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e59.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronbach\u0026rsquo;s \u0026prop;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e * indicates item removed from scale and subscale.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDescriptive statistics from the HPE DEI scale can be found in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Data indicated that participants scored, on average, higher across the Awareness (Factor 1, \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.45) and Action Orientation (Factor 4, \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.25) subscales, while scoring relatively lower across the Empowerment (Factor 3, \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.41) subscale. These results indicate that health professions educators may perceive themselves as aware of DEI topics and willing to engage in the work needed to make a change, but may lack the resources, skill, or confidence in taking action to address DEI issues. Additionally, while items \u0026ldquo;My attitudes and beliefs have no impact on my interactions with others and social groups different from my own\u0026rdquo; and \u0026ldquo;My privileges have little impact on my ability to be an effective health professions educator\u0026rdquo; were not included in the final scale, participants scored relatively low (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.63 and \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.26 respectively) indicating that a significant number of participants do not believe that their privilege and beliefs impact their effectiveness as educators.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eHPE DEI Scale Descriptive Statistics\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHPE DEI Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am aware of my own biases or judgements that I hold toward others and toward social groups different from my own.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am aware of how my background and experiences shape how I view others and social groups different from my own.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy attitudes and beliefs have no impact on my interactions with others and social groups different from my own.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferences between people and social groups are a positive thing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy privileges have little impact on my ability to be an effective health professions educator.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeople's life experiences shape their perceptions of the world around them.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy perceptions of the world have shaped my ability to be an effective health professions educator.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am knowledgeable of equity and inclusion issues impacting health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am aware of best practices and resources to advance equity and inclusion within health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExploring issues of equity and inclusion should not be a high priority for health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBias against specific groups of people plays little role in social determinants of health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am aware of equity and inclusion efforts at my current institution.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI actively seek out resources, training, or developmental opportunities to learn more about issues of equity and inclusion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am confident in my ability to effect change regarding equity and inclusion in health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am comfortable integrating topics on equity and inclusion when engaged in teaching or training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI lack the tools to directly address issues of equity and inclusion within my sphere of influence in health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am unsure how I can use my privileges to combat inequities in health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI want to be a source of positive change regarding equity and inclusion in health professions education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am comfortable engaging in potentially hard conversations regarding issues of equity and inclusion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFactor analysis of the HPE DEI scale resulted in a three-factor structure measuring awareness, empowerment, and action orientation of health professions educators as they address issues of diversity, equity, and inclusion in their teaching. While the sample of this scale validation scored high in awareness and action orientation, the relatively low scores on empowerment indicate that there is more work to be done to foster empowerment to act. Health professions educators\u0026rsquo; personal familiarity and self-focus, or awareness of DEI in their teaching coupled with empowerment through self-efficacy, autonomy, and professional growth can lead to action orientation and the enactment of change-oriented intentions. However, the results of this study demonstrate that empowerment, which is a catalyst for action, is a barrier.\u003c/p\u003e \u003cp\u003eHealth professions education professional organizations have shown a commitment to considering DEI in healthcare education to address health inequities (AAMC, 2021; AAPA, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e); however, these results indicate that more resources are needed to support the efforts of educators. Health professions educators are stretched thin with many managing multiple clinical and academic priorities experiencing stress and burnout (\u0026Ccedil;elme\u0026ccedil;e \u0026amp; Menekay, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lyndon, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Requiring additional DEI training only adds to an already taxing workload, and courses which target the knowledge-domain alone are insufficient to create behavior change (Arlinghaus \u0026amp; Johnston, 2018). Instead, health professions education institutions need to operationalize the commitment to DEI with resources for implementation. For instance, professional development targeting connections between awareness and empowerment, using action-oriented and authentic practice with personalized feedback (Hauer et al, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) may increase faculty beliefs that they are capable of addressing DEI along other subject matter expertise. Further, institutions should provide material support such as course releases and support staff for administering DEI-assessment tools like the Upstate Bias Checklist (Caruso Brown et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough factor 2, relating to educators\u0026rsquo; privilege and DEI, was removed due to the low number of items within the factor, health professions education leaders looking to emphasize the importance of considering DEI within their curriculum should be concerned that a significant number of participants indicated agreement that their privileges and/or beliefs have little to do with their effectiveness as an educator or impact on social groups. Future research should explore how privilege impacts health professions educators\u0026rsquo; beliefs about who should take action related to DEI issues. Such attitudes may prove to be a barrier to change as some health professions educators may adopt the attitude that the lack of DEI considerations in the curriculum is not their problem.\u003c/p\u003e \u003cp\u003eThe HPE DEI Scale provides a reliable measure that goes beyond the limitations of considering cultural knowledge and sensitivity toward multiple cultures by evaluating educators\u0026rsquo; awareness, empowerment, and action orientation related to DEI in the educational and health care context. This scale provides a more nuanced way to explore the competencies necessary for effectively considering DEI in teaching. The work of building DEI into course content requires consideration beyond culture including the systems in place that impact historically excluded populations\u0026rsquo; access to education and health care. The HPE DEI Scale can be used to measure changes in faculty awareness, empowerment, and action orientation as they actively engage in building DEI into their coursework and can lead to evaluation of the resources needed to empower faculty to engage in the process on an ongoing basis.\u003c/p\u003e"},{"header":"Limitations And Conclusion","content":"\u003cp\u003eThis study is limited by a small sample of mostly white, female health professions educators. All data was self-reported therefore responses may have been impacted by acquiescence bias. A replication study with a more demographically diverse faculty sample may provide more insights. Social consequences of the scale\u0026rsquo;s use should be considered (Messick, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) due to the current politicization of \u0026ldquo;divisive issues\u0026rdquo; in education where inclusion of DEI in the curriculum is seen as a threat to the status quo (McMutrie, 2021). Educators may fear social and political retribution as a result of completing the HPE DEI scale. Future research should seek to test criterion validity of the instrument by investigating associations between instructors\u0026rsquo; HPE DEI Scale scores and student-feedback on course evaluations regarding DEI. This is particularly important to explore in relation to feedback of students from marginalized or excluded groups. Additional research should explore relationships between instructors\u0026rsquo; HPE DEI scores and level of DEI training as well. Further work with a sample of faculty in other health professions education fields and in other educational contexts will help strengthen the validity of the instrument. Future work might include a larger sample of participants to conduct measurement invariance analyses across groups such as gender, race, field of study, or level of DEI training. In addition, item modification to suit other types of educators can determine validity beyond health professions education.\u003c/p\u003e \u003cp\u003eDisparities in health care can begin to be addressed by educating students in health occupations about the need to consider DEI in their practice leading to improved health care outcomes for all populations (Bouye et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Jackson \u0026amp; Gracia, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Medical education content has been found to include race, ethnicity, gender and other characteristic-related bias (Caruso Brown et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This bias can lead to health professionals and health professions students holding false beliefs about biological differences between races with race often presented in the educational context as a biological risk factor (Hoffman et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Tsai et al. \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The misinformation is just one example of how existing educational structures contribute to disparities in treatment, and how aware, empowered, and action-oriented educators can disabuse students of biased health-related notions.\u003c/p\u003e \u003cp\u003eWhile health professions education professional organizations have emphasized a commitment to diversifying their professions and addressing health inequities while fostering a culture of DEI, it is important to develop a plan to measure progress. The HPE DEI scale is a tool that can be used to evaluate health professions educators\u0026rsquo; awareness, empowerment, and action orientation as they engage in teaching and learning about DEI and can be adapted by educators outside the US and in other professions. Health professions educators are training future health professionals, therefore their attitudes about building DEI into their course content can lead to increased awareness, empowerment, and action orientation in the students they teach.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors were involved in conceiving the study and reviewing the manuscript. Author 1 substantially contributed to the literature review and discussion. Author 2 substantially contributed to methods and results, and Author 3 substantially contributed to literature review and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received to assist with the conducting of this study nor preparation of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire and methodology for this study was approved by the Author 1’s IRB.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eAmerican Association of Medical Colleges (2021). 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Increasing family medicine faculty diversity still lags population trends. \u003cem\u003eThe Journal of the American Board of Family Medicine\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(1), 100\u0026ndash;103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3122/jabfm.2017.01.160211\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"diversity, equity, inclusion, DEI, health professions education, medical education, scale validation","lastPublishedDoi":"10.21203/rs.3.rs-2653012/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2653012/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eEducating students in health occupations about the need to consider DEI in their practice can lead to improved health care outcomes for all populations. Measuring health professions educators’ awareness, empowerment, and action orientation toward diversity, equity, and inclusion (DEI) is one step toward addressing disparities in health care. In this article, thedevelopment and examination of the psychometric properties of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI) are described. \u0026nbsp;Exploratory factor analysis was performed on data collected from health professions educators at seven higher education institutions in the United States. Factor analysis resulted in a three-factor structure measuring awareness, empowerment, and action orientation of health professions educators as they address issues of diversity, equity, and inclusion in their teaching. The resulting scale provides a nuanced way to explore the competencies necessary for effectively considering diversity, equity, and inclusion in health professions education. The HPE DEI is adaptable for educators across degree levels and academic disciplines.\u003c/p\u003e","manuscriptTitle":"Measuring DEI Awareness, Empowerment, and Action Orientation: Validation of the Health Professions Educators Diversity, Equity, and Inclusion Scale (HPE DEI)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-08 10:45:23","doi":"10.21203/rs.3.rs-2653012/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0a5bddc1-3e0d-474c-83ea-e30c514aa1f7","owner":[],"postedDate":"March 8th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-07-09T14:29:27+00:00","versionOfRecord":[],"versionCreatedAt":"2023-03-08 10:45:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2653012","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2653012","identity":"rs-2653012","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}