Bringing Needed Change to Medical Student Well-Being: A Call to Expand Accreditation Requirements.

Issue: Noting high rates of burnout, depression, and suicidality among medical students, academic medical communities are trying to identify preventive and curricular measures that protect and promote student well-being. To date, the effectiveness of these efforts is unclear. In addition, evidence increasingly suggests that the major drivers of distress appear to be factors within the social, learning, and work environments. Specific to medical schools in the United States, neither the Liaison Committee on Medical Education nor the Commission on Osteopathic College Accreditation include accreditation standards regarding well-being curricula and, as such, these curricula are not well-integrated into students' medical school experience. Current accreditation standards also do not specifically require institutions to assess or address systemic factors of the learning environment that negatively affect student well-being. Evidence: This paper proposes expanding current Liaison Committee on Medical Education and Commission on Osteopathic College Accreditation standards on professionalism to incorporate well-being as a core component of professional identity formation by requiring individual and institutional-level actions. Proposed changes to accreditation standards include (1) institutional assessment of the impact of the learning environment on student well-being; (2) continuous quality improvement efforts to address structural factors associated with student well-being and modification of practices that impair student well-being; and (3) integrated curriculum with related assessment to educate students on empirically-supported strategies for well-being. Implications: Refining undergraduate medical education accreditation standards in the United States to include language specific to student well-being will facilitate long overdue changes to the learning environment. In the end, the goal is not just to improve medical student well-being, but to provide a workforce better equipped for a sustainable and meaningful career.

Reclaiming the mission of academic medicine: An examination of institutional responses to (anti)racism.

PURPOSE: The utility of institutional statements is said to provide clarity and reinforcement of an institution's goal. Unfortunately, it can also be argued that these statements are in clear misalignment between the words described and the environments that faculty, students, trainees, and staff of color face. The purpose of this study was to analyze academic medicine institutional statements that responded to 2020 racial tensions following the murders of George Floyd, among others, and the subsequent nationwide protests against police brutality. METHODS: We conducted a manifest content analysis of institutional statements generated by academic medical centers after George Floyd's murder. We used manifest content analysis to gain insights into how institutional statements connect structural racism to the mission of academic medicine. We collected and examined institutional statements from 26 academic medicine centers. Selection parameters included statements that were publicly available and published by the institutions during a 2-week period. We conducted a four-stage analysis: decontextualization, recontextualization, categorization, and compilation. To better understand the collection of statements, we plotted these institutional statements according to the most salient discussed themes. RESULTS: Overall, institutional statements discussed racism through three subthemes: identifying the racial implications of health disparities, issuing a call to action to address racism, and decentering race. Absent language is also noted. Second, institutional statements evoked institutional values by expressing an explicit connection with the academic medicine mission, naming the value of social justice, and emphasizing the concept of community. Finally, institutional statements largely discussed public health in connection with racism or with institutional values. CONCLUSION: Our study determines a much-needed reconnection to the mission of academic medicine. Reclaiming the social mission will be a major step toward recentering the foundation of institutional actions. This call is what ultimately will improve the health and well-being of marginalized populations.

Integrating Radiation Oncology Into Undergraduate Medical Education.

Cancer is one of the most important public health problems. However, medical education has not advanced at the same rate when it comes to cancer education. Currently, the United States Medical Licensing Examination subject examinations do not cover radiation oncology, prevention, and survivorship planning in its assessment model. Incorporating medical oncology and radiation oncology training into the undergraduate medical education curriculum can have a significant benefit in training future physicians. In this paper, we review current literature and propose some ideas that can help incorporate oncology, and specifically radiation oncology, into undergraduate medical education.

Medical School Strategies to Address Student Well-Being: A National Survey.

PURPOSE: To describe the breadth of strategies U.S. medical schools use to promote medical student well-being. METHOD: In October 2016, 32 U.S. medical schools were surveyed about their student well-being initiatives, resources, and infrastructure; grading in preclinical courses; and learning communities. RESULTS: Twenty-seven schools (84%) responded. Sixteen (59%) had a student well-being curriculum, with content scheduled during regular curricular hours at most (13/16; 81%). These sessions were held at least monthly (12/16; 75%), and there was a combination of optional and mandatory attendance (9/16; 56%). Most responding schools offered a variety of emotional/spiritual, physical, financial, and social well-being activities. Nearly one-quarter had a specific well-being competency (6/27; 22%). Most schools relied on participation rates (26/27; 96%) and student satisfaction (22/27; 81%) to evaluate effectiveness. Sixteen (59%) assessed student well-being from survey data, and 7 (26%) offered students access to self-assessment tools. Other common elements included an individual dedicated to overseeing student well-being (22/27; 82%), a student well-being committee (22/27; 82%), pass/fail grading in preclinical courses (20/27; 74%), and the presence of learning communities (22/27; 81%). CONCLUSIONS: Schools have implemented a broad range of well-being curricula and activities intended to promote self-care, reduce stress, and build social support for medical students, with variable resources, infrastructure, and evaluation. Implementing dedicated well-being competencies and rigorously evaluating their impact would help ensure appropriate allocation of time and resources and determine if well-being strategies are making a difference. Strengthening evaluation is an important next step in alleviating learner distress and ultimately improving student well-being.