From leadership research to district action: Navigating Nonlinear Pathways: Challenges and Opportunities for Diversity, Equity, and Inclusion Leaders in Academic Emergency Medicine

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Objectives Diversity, equity, and inclusion (DEI) leadership roles have grown in academic emergency medicine (EM). We sought to elucidate specific pathways to DEI leadership roles among current DEI leaders in academic EM. Methods From March to May 2023, we conducted semistructured, qualitative interviews with DEI leaders in academic EM across 5 US regions to investigate their pathways to leadership. Participants were recruited via email using Accreditation Council for Graduate Medical Education-accredited EM residency websites and the Academy for Diversity and Inclusion in EM. After recording and transcribing the interviews, we used an inductive approach to identify major themes. Results Of 56 DEI leaders contacted, 25 agreed to participate, and 21 were interviewed. The median (range) interview duration was 34 (25-63) minutes. Leadership titles included directors, chairs, vice chairs, committee chairs, chiefs, advisors, and deans. Three major themes emerged: (1) nonlinear pathways—participants reached DEI roles through informal assumption, volunteering, or self-creation, often without initial aspiration or compensation; (2) undefined roles and expectations—roles and responsibilities were often determined by leaders themselves, with advantages and disadvantages; (3) variable perceived value in promotions—participants felt DEI efforts were frequently undervalued in academic promotion, with mentorship highlighted as crucial for translating DEI activities into academic achievements. Conclusion Our study provides important insights not only into the pathways to DEI leadership among current leaders in academic EM but also into the challenges and opportunities DEI leaders perceive when navigating roles, responsibilities, and academic promotion. Keywords: diversity, equity, inclusion, emergency medicine

Study methods

We performed a descriptive qualitative study. As part of our recruitment process, we reviewed all US Accreditation Council for Graduate Medical Education-accredited EM residency websites for DEI leadership positions to develop a list of potential participants, supplemented with institutional or national DEI leaders known to executive committee members of the Academy for Diversity and Inclusion in EM. Given the geographic variation in DEI climates at higher educational institutions, we purposefully sampled at least 2 to 3 participants from 5 geographic regions of the US: Northeast, Southwest, West, Southeast, and Midwest. After being recruited via email (Supplementary Appendix 1), participants consented orally and received $50 compensation once they completed a virtual interview. The Baylor College of Medicine Institutional Review Board provided ethics approval. We followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines (Supplementary Appendix 2).7

Limitations

Our study was limited to DEI leaders in academic EM; therefore, our findings are specialty-specific. However, many of the processes and structures surrounding leadership, advancement, and promotion are shared among other academic specialties. Participant leadership positions varied greatly (eg, committee chair vs vice chair, departmental vs institutional), which limits our ability to comment on any one specific role. Nevertheless, our goal was to investigate the pathways to DEI leadership roles rather than the roles themselves. Although it is possible that framing the broader study during recruitment impacted participant responses in this report, we began all interviews with broad, open-ended questions about pathways to DEI leadership positions and did not specifically probe other topics until the latter half of the interview. Finally, we acknowledge the possibility of investigator bias, which we attempted to mitigate by creating a diverse study team and deriving themes through consensus.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Select one recurring district decision. Publish the decision owner, evidence requirements, consultation process and appeal route; test the process on a bounded low-risk decision. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Track decision time, unresolved objections, documented reasons, appeals and access differences. Review whether the process changes who can participate and who carries the burden. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Melanie F Molina; Annika Bhananker; Beatrice Torres; Dalia Owda; Edgardo Ordoñez; Anita N Chary. Navigating Nonlinear Pathways: Challenges and Opportunities for Diversity, Equity, and Inclusion Leaders in Academic Emergency Medicine. Journal of the American College of Emergency Physicians Open (2025-02-14). https://doi.org/10.1016/j.acepjo.2025.100060

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.