Development and Validation of an Instrument for Measuring Equality, Diversity and Inclusivity (EDI) in Medical Education Teaching Resources: The GRADES10.

Higher education institutions around the world have a responsibility to diversify their course content. This is an important consideration to ensure that students are prepared to serve a diverse population once they graduate, however, a lack of diversity representation in medical school curricula in particular, is reported in the literature. A paucity of reliable resources to support creating more inclusive content is also reported. This study developed and validated a diversity measurement instrument, designed to look at representation in the areas of gender, religion, age, disability, ethnicity/race, sexuality, and socio-economic status. Early prototypes were sent to experts for validity testing and using their feedback, improvements and iterations were made to the instrument until the final instrument was agreed: the GRADES10©. The instrument was then applied to a variety of medical education resources to test for rater-reliability. An accompanying user guide was developed to support users with the application of the GRADES10© in practice. Face validity was conducted by 10 experts on several iterations of the instrument from the early prototype (GRADESs7), until the final agreed GRADES10©. Rater-reliability was calculated by intraclass correlation coefficient (ICC) and Cronbach's Alpha measure of internal consistency. The GRADES10© instrument was shown to have an ICC of 0.83% (SD 0.725-0.907) p= < .0001, and Cronbach's Alpha of 0.97. Overall, this study has shown that the validated GRADES10© instrument is able to measure diversity in medical teaching resources reliably. The GRADES10© has the potential to contribute to creating a more inclusive learning environment by allowing its users to apply a diversity metric to their educational materials, to identify gaps and areas for improvement. If applied by medical schools and organisations offering continuing medical education courses in future, the GRADES10© may impact the grassroots of medical education diversification, which may have a beneficial effect on medical student and doctors' attitudes, experiences and ultimately on patient care.