ABSTRACT
Background
Academic medicine programs face compounded challenges from public health crises, health inequities, and evolving federal policies pertaining to Diversity, Equity, and Inclusion (DEI). Older adults and individuals living with serious illness—particularly those from marginalized communities—experienced greater morbidity and mortality during the COVID-19 pandemic and may continue to see disproportionately negative outcomes amid 2025 federal regulatory changes.
Methods
Within a Department of Geriatrics and Palliative Medicine, a DEI initiative evolved into the MOSAIC Council (Mission Oriented Strategies Advancing Inclusive Communities)—reframing its scope, governance, and program activities to preserve psychological safety, engagement, and institutional relevance. MOSAIC and departmental leadership defined the program’s mission to: (1) foster a supportive and inclusive learning and work environment, (2) develop responsive approaches to discrimination and bias, and (3) provide accessible resources to support all department members. Activities consisted of lectures, facilitated forums, workshops, and community-building experiences, with ongoing feedback used to guide program refinement.
Results
From 2021 to 2025, MOSAIC demonstrated sustained engagement, delivering more than 140 sessions, consistent attendance, and positive participant feedback. Structural and resilient adaptations included expansion of the champion team, iterative feedback and needs assessments, and prioritization of flexible, community-informed programming. Focus on internal community building and psychological safety supported program growth and resilience and facilitated integration of MOSAIC principles into departmental culture and practices.
Conclusions
MOSAIC demonstrates that internal DEI development in a geriatric and palliative department can be sustained through intentional resilience and adaptive design, despite restrictive policy environments. This model offers a pragmatic framework for academic health programs seeking to improve workforce environment and advance equitable care for older adults and seriously ill populations while navigating evolving regulatory landscapes. Future directions include extending this framework to patient and caregiver communities.