Tools for Discussing Identity and Privilege Among Medical Students, Trainees, and Faculty.

Introduction: Physicians and students of all backgrounds should be prepared to interact with patients of various socioeconomic, racial, ethnic, gender, religious, and sexual orientation identities. The approach described here emphasizes how important it is for physicians and physicians-in-training to develop self-awareness before engaging with patients. Methods: Over the course of 6 months, we conducted workshops on identity awareness for four groups: (1) fourth-year medical students (N = 6), (2) first-year medical students (N = 88), (3) faculty and staff (N = 11), and (4) residents/fellows (N = 4). Exercises in this workshop prompted learners to reflect on the development of social and professional identities through the use of an identity wheel activity, a group reading about professional identity formation, and a hands-on activity modeling social inequity. Results: Our analysis of responses to pre- and postsurveys indicated that learners in the first-year medical student group (N = 88) experienced increased awareness and acknowledgment of social identity, professional identity, professional relationships, and the concepts of privilege and difference following participation in this workshop. Discussion: These exercises guide learners toward critical thinking about privilege and identity to better prepare them for culturally inclusive patient interactions. These materials can be used with physicians at various levels of training. The earlier they are used, the more time learners will have to reflect on social and professional identities before interacting with patients.

Interventional pain physicians' experiences of and attitudes toward surgical privileging.

BACKGROUND AND OBJECTIVES: No consensus guidelines exist on surgical privilege credentialing for nonsurgeons. We queried a group of academic interventional pain physicians about their experiences acquiring such credentials after training, how this process reflected their training, and their current attitudes toward both processes. METHODS: We designed an interactive, computer-based questionnaire and sent this electronically to the directors of all 93 accredited pain medicine subspecialty fellowship programs in the United States. The questionnaire included 17 items regarding interventional pain medicine training, procedures done, experience of credentialing for surgical privileges, and attitudes toward these processes, with 1 additional space for comments. RESULTS: Of the 93 program directors, 46 (49.5%) responded to our questionnaire. Forty-one (89%) of the respondents were anesthesiologists, and 43 (93%) included some form of implantation procedure in their current practice. Most (83%) of the respondents did fewer than 25 implants per year. Experience doing implant procedures during training varied widely among respondents: 43% did fewer than 5 implant procedures during fellowship; 33.3% did at least 15. Most respondents did their own wound closures and did not feel that immediate surgical backup should be required for interventional pain procedures. Most respondents (78%) felt that pertinent surgical training should be mandatory before credentialing, but fewer than 20% reported having been required to have even a proctoring experience before credentialing. CONCLUSIONS: Experience doing implantation procedures during fellowship training and subsequent experience with hospital surgical credentialing seems to vary widely, even among interventional pain physicians associated with academic training programs.