Developing Evidence for Equitable Assessment Characteristics Based on Clinical Learner Preferences Using Discrete Choice Experiments.

PURPOSE: Medical education is only beginning to explore the factors that contribute to equitable assessment in clinical settings. Increasing knowledge about equitable assessment ensures a quality medical education experience that produces an excellent, diverse physician workforce equipped to address the health care disparities facing patients and communities. Through the lens of the Anti-Deficit Achievement framework, the authors aimed to obtain evidence for a model for equitable assessment in clinical training. METHOD: A discrete choice experiment approach was used which included an instrument with 6 attributes each at 2 levels to reveal learner preferences for the inclusion of each attribute in equitable assessment. Self-identified underrepresented in medicine (UIM) and not underrepresented in medicine (non-UIM) (N = 306) fourth-year medical students and senior residents in medicine, pediatrics, and surgery at 9 institutions across the United States completed the instrument. A mixed-effects logit model was used to determine attributes learners valued most. RESULTS: Participants valued the inclusion of all assessment attributes provided except for peer comparison. The most valued attribute of an equitable assessment was how learner identity, background, and trajectory were appreciated by clinical supervisors. The next most valued attributes were assessment of growth, supervisor bias training, narrative assessments, and assessment of learner's patient care, with participants willing to trade off any of the attributes to get several others. There were no significant differences in value placed on assessment attributes between UIM and non-UIM learners. Residents valued clinical supervisors valuing learner identity, background, and trajectory and clinical supervisor bias training more so than medical students. CONCLUSIONS: This study offers support for the components of an antideficit-focused model for equity in assessment and informs efforts to promote UIM learner success and guide equity, diversity, and inclusion initiatives in medical education.

Leveraging Clerkship Experiences to Address Segregated Care: A Survey-Based Approach to Student-Led Advocacy.

Phenomenon: Many academic medical centers (AMCs) have a history of separating patients on the basis of insurance status. In New York State, where Black and Latino patients are more than twice as likely to have Medicaid as white patients, this practice leads to de facto racial segregation in healthcare. Emerging evidence suggests that this segregation of care is detrimental to both patient care and medical education. Medical students are uniquely positioned to be change makers in this space but face significant barriers to speaking out about these disparities and successfully advocating for institutional change. Approach: The authors designed, piloted, and distributed a 16-item survey on segregated care to third-year medical students at a large academic medical center in New York City. Students were asked both open- and close-ended questions about witnessing separation and differences in patient care on the basis of insurance during their clinical rotations. The survey was shared with 140 students in March 2019 with a response rate of 46.4% (n = 65). Preliminary findings were presented to school and hospital administrators. Findings: More than half of survey respondents reported witnessing separation of patient care or differences in patient care on the basis of insurance (56.3%, n = 36 and 51.6%, n = 33 respectively). Many students reported that these experiences contributed to cynicism and burnout. The authors leveraged these results to advocate for quality improvement measures. In Ob-Gyn, department leadership launched a clinical transformation taskforce and recruited a new Vice Chair of Clinical Transformation/Chief Patient Experience Officer, whose role includes addressing segregated care and disparities in health outcomes. The hospital committed to establishing integrated practices in new clinical spaces and launching a similar survey among house staff. Insights: Many medical students experience and participate in segregated care during their clerkships and this has the potential to impact their education. Medical students are well-positioned to recognize segregated care across health systems and leverage their experiences for advocacy. A survey-based approach can be a powerful tool enabling students to collect these experiences to address segregated care and other health equity issues.

Commentary: Racism and Bias in Health Professions Education: How Educators, Faculty Developers, and Researchers Can Make a Difference.

The Research in Medical Education (RIME) Program Planning Committee is committed to advancing scholarship in and promoting dialogue about the critical issues of racism and bias in health professions education (HPE). From the call for studies focused on underrepresented learners and faculty in medicine to the invited 2016 RIME plenary address by Dr. Camara Jones, the committee strongly believes that dismantling racism is critical to the future of HPE.The evidence is glaring: Dramatic racial and ethnic health disparities persist in the United States, people of color remain deeply underrepresented in medical school and academic health systems as faculty, learner experiences across the medical education continuum are fraught with bias, and current approaches to teaching perpetuate stereotypes and insufficiently challenge structural inequities. To achieve racial justice in HPE, academic medicine must commit to leveraging positions of influence and contributing from these positions. In this Commentary, the authors consider three roles (educator, faculty developer, and researcher) represented by the community of scholars and pose potential research questions as well as suggestions for advancing educational research relevant to eliminating racism and bias in HPE.

The Human Rights and Social Justice Scholars Program: a collaborative model for preclinical training in social medicine.

BACKGROUND: Despite the importance of the role social justice takes in medical professionalism, the need to train health professionals to address social determinants of health, and medical trainees' desire to eliminate health disparities, undergraduate medical education offers few opportunities for comprehensive training in social justice. The Human Rights and Social Justice (HRSJ) Scholars Program at the Icahn School of Medicine at Mount Sinai is a preclinical training program in social medicine consisting of 5 components: a didactic course, faculty and student mentorship, research projects in social justice, longitudinal policy and advocacy service projects, and a career seminar series. OBJECTIVES: The aim of this article is to describe the design and implementation of the HRSJ curriculum with a focus on the cornerstone of the HRSJ Scholars Program: longitudinal policy and advocacy service projects implemented in collaboration with partner organizations in East Harlem. Furthermore, we describe the results of a qualitative survey of inaugural participants, now third-year medical students, to understand how their participation in this service-learning component affected their clinical experiences and professional self-perceptions. CONCLUSION: Ultimately, through the implementation and evaluation of the HRSJ Scholars Program, we demonstrate an innovative model for social justice education; the enduring effect of service-learning experiences on participants' knowledge, skills, and attitudes; and the potential to increase community capacity for improved health through a collaborative educational model.

Succeeding as a Clinician Educator: useful tips and resources.

Clinician Educators (CEs) play an essential role in the education and patient care missions of academic medical centers. Despite their crucial role, academic advancement is slower for CEs than for other faculty. Increased clinical productivity demands and financial stressors at academic medical centers add to the existing challenges faced by CEs. This perspective seeks to provide a framework for junior CEs to consider with the goal of maximizing their chance of academic success. We discuss six action areas that we consider central to flourishing at academic medical centers: 1. Clarify what success means and define goals; 2. Seek mentorship and be a responsible mentee; 3. Develop a niche and engage in relevant professional development; 4. Network; 5. Transform educational activities into scholarship; and 6. Seek funding and other resources.

Impact of a 360-degree professionalism assessment on faculty comfort and skills in feedback delivery.

BACKGROUND: Professionalism is identified as a competency of resident education. Best approaches to teaching and evaluating professionalism are unknown, but feedback about professionalism is necessary to change practice and behavior. Faculty discomfort with professionalism may limit their delivery of feedback to residents. OBJECTIVES: A pilot program to implement a 360-degree evaluation of observable professionalism behaviors and determine how its use impacts faculty feedback to residents. DESIGN: Internal Medicine (IM) residents were evaluated during ambulatory rotations using a 360-degree assessment of professional behaviors developed by the National Board of Medical Examiners(R). Faculty used evaluation results to provide individual feedback to residents. PATIENTS/PARTICIPANTS: Fifteen faculty members. MEASUREMENTS AND MAIN RESULTS: Faculty completed pre- and post-intervention surveys. Using a 7-point Likert scale, faculty reported increased skill in giving general feedback (4.85 vs 4.36, p < .05) and feedback about professionalism (4.71 vs 3.57, p < .01) after the implementation of the 360-degree evaluation. They reported increased comfort giving feedback about professionalism (5.07 vs 4.35, p < .05) but not about giving feedback in general (5.43 vs 5.50). CONCLUSIONS: A 360-degree professionalism evaluation instrument used to guide feedback to residents improves faculty comfort and self-assessed skill in giving feedback about professionalism.