Guiding Academic Clinician Educators at Research-Intensive Institutions: a Framework for Chairs, Chiefs, and Mentors.

Department chairs and division chiefs at research-intensive academic medical centers often find mentoring clinician educators challenging. These faculty constitute the majority of academic physicians. Supporting excellent clinician educators is key to ensuring high-quality patient care and developing tomorrow's physicians. Little has been written for leaders on strategies to advance academic clinician educators' career success. We present a framework to guide chairs, chiefs, and mentors seeking to address clinician educator retention and satisfaction in academic medical centers.

Strategies for forming effective women's groups.

Women are under-represented at the highest levels of leadership in health care, so many institutions have started forming "women in medicine" affinity groups. In this The Clinical Teacher's Toolbox, we review the history of women's professional peer-to-peer networking groups in health care, describe the rationale for establishing a women's group, discuss the goals and common content covered by successful women's groups, share best practices on forming and sustaining women's groups, and describe common pitfalls to avoid. When forming a women's group, identifying the group's vision, mission, and primary aim statements are important, and early meetings should deliberately establish a tone of inclusion. We acknowledge that the term "women's groups" implies that gender identity is binary - in reality, these groups are for all who want to combat gender inequities in health care. While early stages of women's groups typically focus on community-building, peer networking, and inviting guest speakers to speak about relevant topics, successful groups often ultimately pivot to advocacy, internal capacity-building, evaluation, and dissemination. To sustain and maintain the group, succession planning, regular opportunities for evaluation, and deliberate planning are essential. Although usual principles of successful small group creation apply, this article outlines unique considerations for how women's groups can advance gender equity.

Toward Creating Equity in Awards Received During Medical School: Strategic Changes at One Institution.

Membership in the Alpha Omega Alpha Honor Medical Society (AΩA) is a widely recognized achievement valued by residency selection committees and employers. Yet research has shown selection favors students from racial/ethnic groups not underrepresented in medicine (not-UIM). The authors describe efforts to create equity in AΩA selection at the University of California, San Francisco, School of Medicine, through implementation of a holistic selection process, starting with the class of 2017, and present outcomes.Informed by the definition of holistic review, medical school leaders applied strategic changes grounded in evidence on inclusion, mitigating bias, and increasing opportunity throughout the AΩA selection process. These addressed increasing selection committee diversity, revising selection criteria and training committee members to review applications using a new instrument, broadening student eligibility and inviting applications, reviewing blinded applications, and making final selection decisions based on review and discussion of a rank-ordered list of students that equally weighted academic achievement and professional contributions.The authors compared AΩA eligibility and selection outcomes for 3 classes (2014-2016) during clerkship metric-driven selection, which prioritized academic achievement, and 3 classes (2017-2019) during holistic selection. During clerkship metric-driven selection, not-UIM students were 4 times more likely than UIM students to be eligible for AΩA (P = .001) and 3 times more likely to be selected (P = .001). During holistic selection, not-UIM students were 2 times more likely than UIM students to be eligible for AΩA (P = .001); not-UIM and UIM students were similarly likely to be selected (odds ratio = .7, P = .12)This new holistic selection process created equity in representation of UIM students among students selected for AΩA. Centered on equity pedagogy, which advocates dismantling structures that create inequity, this holistic selection process has implications for creating equity in awards selection during medical education.

Designing Well-Being: Using Design Thinking to Engage Residents in Developing Well-Being Interventions.

PROBLEM: Improving well-being in residency requires solutions that focus on organizational factors and the individual needs of residents, yet there are few examples of successful strategies to address this challenge. Design thinking (DT), or human-centered design, is an approach to problem-solving that focuses on understanding emotions and human dynamics and may be ideally suited to tackling well-being as a complex problem. The authors taught residents to use DT techniques to identify, analyze, and address organizational well-being challenges. APPROACH: Internal medicine residents at the University of California, San Francisco completed an 8-month DT program in 2016-2017. The program consisted of four 2-hour workshops with small group project work between sessions. In each session, resident teams shared their progress and analyzed emerging themes to solve well-being problems. At the conclusion of the program, they summarized the final design principles and recommendations that emerged from their work and were interviewed about DT as a strategy for developing well-being interventions for residents. OUTCOMES: Eighteen residents worked in teams to design solutions to improve: community and connection, space for reflection, peer support, and availability of individualized wellness. The resulting recommendations led to new interventions to improve well-being through near-peer communities. Residents emphasized how DT enhanced their creative thinking and trust in the residency program. They reported that not having enough time to work on projects between sessions and losing momentum during their clinical rotations were their biggest challenges. NEXT STEPS: Residents found DT useful for completing needs assessments, piloting interventions, and outlining essential design principles to improve well-being in residency. DT's focus on human values may be particularly suited to developing well-being interventions to enhance institutional community and culture. One outcome-that DT promoted creativity and trust for participants-may have applications in other spheres of medical education.

Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs.

Background. Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods. STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18-39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results. Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion. The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420.

Applying the COM-B model to creation of an IT-enabled health coaching and resource linkage program for low-income Latina moms with recent gestational diabetes: the STAR MAMA program.

BACKGROUND: One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on low-cost changes in eating, physical activity and weight management can lower diabetes risk and delay onset, these programs have yet to be tailored to postpartum Latina women. This study aims to tailor a IT-enabled health communication program to promote DPP-concordant behavior change among postpartum Latina women with recent gestational diabetes. The COM-B model (incorporating Capability, Opportunity, and Motivational behavioral barriers and enablers) and the Behavior Change Wheel (BCW) framework, convey a theoretically based approach for intervention development. We combined a health literacy-tailored health IT tool for reaching ethnic minority patients with diabetes with a BCW-based approach to develop a health coaching intervention targeted to postpartum Latina women with recent gestational diabetes. Current evidence, four focus groups (n = 22 participants), and input from a Regional Consortium of health care providers, diabetes experts, and health literacy practitioners informed the intervention development. Thematic analysis of focus group data used the COM-B model to determine content. Relevant cultural, theoretical, and technological components that underpin the design and development of the intervention were selected using the BCW framework. RESULTS: STAR MAMA delivers DPP content in Spanish and English using health communication strategies to: (1) validate the emotions and experiences postpartum women struggle with; (2) encourage integration of prevention strategies into family life through mothers becoming intergenerational custodians of health; and (3) increase social and material supports through referral to social networks, health coaches, and community resources. Feasibility, acceptability, and health-related outcomes (weight loss, physical activity, consumption of healthy foods, breastfeeding, and glucose screening) will be evaluated at 9 months postpartum using a randomized controlled trial design. CONCLUSIONS: STAR MAMA provides a DPP-based intervention that integrates theory-based design steps. Through systematic use of behavioral theory to inform intervention development, STAR MAMA may represent a strategy to develop health IT intervention tools to meet the needs of diverse populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT02240420.

Medical Students' Perceptions of Surgeons: Implications for Teaching and Recruitment.

OBJECTIVE: The purpose of this study was to assess first-year medical students' implicit perceptions of surgeons, focusing on the roles of gender and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men). DESIGN: Survey study. Each survey had 1 of 8 possible scenarios; all began with a short description of a surgeon who was described as accomplished and well trained, then varied by surgeon gender (male/female), surgeon demeanor (agentic/communal), and type of surgery (breast cancer/lung cancer). Using a 0 to 5 scale, respondents rated their perception of the surgeon through 5 questions. These 5 items were averaged to create a composite perception score scaled from 0 to 5. SETTING: Surveys were administered at the University of California, San Francisco, and the University of California, Los Angeles. PARTICIPANTS: We administered surveys to 333 first-year medical students who could read English and voluntarily agreed to participate. RESULTS: A total of 238 students responded (71.5%). They preferred the communal vs agentic surgeon (4.2 ± 0.7 vs 3.9 ± 0.7, p = 0.002) and male medical students perceived surgeons more favorably than female medical students did (4.2 ± 0.6 vs 4.0 ± 0.8, p = 0.036). The preference score did not differ according to surgeon gender (female 4.12 vs male 3.98, p = 0.087). There were no significant interactions between the factors of student gender, surgeon gender, or demeanor. Students who reported an interest in surgery as a career did not perceive surgeons more favorably than the students interested in other fields (4.3 ± 0.7 vs 4.0 ± 0.7 respectively, p = 0.066). CONCLUSIONS: Based on our findings, surgeon educators would likely find success in teaching and recruiting medical students by employing a communal demeanor in their interactions with all students, regardless of the students' gender or stated interest in surgery.

The key role of a transition course in preparing medical students for internship.

Among the core transitions in medical education is the one from medical school to residency. Despite this challenging transition, the final year of medical school is known as lacking structure and clarity. The authors examine the preparation of medical students for the professional and personal challenges of internship in the context of transition courses. They first describe the development of a residency transition course, offered since 2001 at the University of California, San Francisco, School of Medicine (UCSF), exploring aspects of a needs assessment, course goals and content, core competencies, and course implementation. They then critically analyze the course, judging it successful based on high subjective satisfaction scores and increased perceived preparedness data. Next, the authors discuss the national context of transition courses, perspectives of various stakeholders, and lessons learned from the UCSF experience. Finally, they consider future directions, suggesting that internship transition courses be a standard part of the medical school curriculum.

Developing educators, investigators, and leaders during internal medicine residency: the area of distinction program.

BACKGROUND: Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices. CONTEXT AND PURPOSE: To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data. METHODS AND PROGRAM EVALUATION: We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs. RESULTS: AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate. CONCLUSIONS: The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests 5 empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.

Teaching about health care disparities in the clinical setting.

Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner's need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching.