Five Strategies Leaders in Academic Medicine Can Implement Now to Enhance Gender Equity.

Abundant disparities for women in medicine contribute to many women physicians considering leaving medicine. There is a strong financial and ethical case for leaders in academic medicine to focus on strategies to improve retention. This article focuses on five immediate actions that leaders can take to enhance gender equity and improve career satisfaction for all members of the workplace.

Characteristics of internal medicine residents who successfully match into cardiology fellowships.

BACKGROUND: The unique traits of residents who matriculate into subspecialty fellowships are poorly understood. We sought to identify characteristics of internal medicine (IM) residents who match into cardiovascular (CV) fellowships. METHODS: We conducted a retrospective cohort study of 8 classes of IM residents who matriculated into residency from 2007 to 2014. The primary outcome was successful match to a CV fellowship within 1 year of completing IM residency. Independent variables included residents' licensing exam scores, research publications, medical school reputation, Alpha Omega Alpha (AOA) membership, declaration of intent to pursue CV in the residency application personal statement, clinical evaluation scores, mini-clinical evaluation exercise scores, in-training examination (ITE) performance, and exposure to CV during residency. RESULTS: Of the 339 included residents (59% male; mean age 27) from 120 medical schools, 73 (22%) matched to CV fellowship. At the time of residency application, 104 (31%) had ≥1 publication, 38 (11%) declared intention to pursue CV in their residency application personal statement, and 104 (31%) were members of AOA. Prior to fellowship application, 111 (33%) completed a CV elective rotation. At the completion of residency training, 108 (32%) had ≥3 publications. In an adjusted logistic regression analysis, declaration of intention to pursue CV (OR 6.4, 99% CI 1.7-23.4; p < 0.001), completion of a CV elective (OR 7.3, 99% CI 2.8-19.0; p < 0.001), score on the CV portion of the PGY-2 ITE (OR 1.05, 99% CI 1.02-1.08; p < 0.001), and publication of ≥3 manuscripts (OR 4.7, 99% CI 1.1-20.5; p = 0.007) were positively associated with matching to a CV fellowship. Overall PGY-2 ITE score was negatively associated (OR 0.93, 99% CI 0.90-0.97; p < 0.001) with matching to a CV fellowship. CONCLUSIONS: Residents' matriculation into CV fellowships was associated with declaration of CV career intent, completion of a CV elective rotation, CV medical knowledge, and research publications during residency. These findings may be useful when advising residents about pursuing careers in CV. They may also help residents understand factors associated with a successful match to a CV fellowship. The negative association between matching into CV fellowship and overall ITE score may indicate excessive subspecialty focus during IM residency.

Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion.

Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.

Use of a Coordinated Social Media Strategy to Improve Dissemination of Research and Collect Solutions Related to Workforce Gender Equity.

Background: To increase awareness, search for solutions, and drive change, disparity-related research needs to be strategically disseminated. This study aimed to quantify whether a social media strategy could: (1) amplify dissemination of gender equity-related articles and (2) collect proposed solutions to gender equity issues. Methods: In April 2018, eight published journal articles covering separate gender equity issues were presented in a 1-hour Twitter chat hosted by Physician's Weekly. Metrics data were collected before, during, and after the chat. During the chat, one question related to each article was tweeted at a time. Qualitative data were extracted from responses and evaluated for thematic content. Results: In the 16-hour period during and following the chat, we tallied 1500 tweets from 294 participants and 8.6 million impressions (potential views). The Altmetric Attention Score of each article increased (average, 126.5 points; range, 91-208 points). Within the respective journal, the Altmetric Rank of seven articles improved (range, 3 to ≥19), while the eighth maintained its #1 rank. The one article for which share and download data were available experienced a 729% increase in shares following prechat posts and another 113% bump after the chat, a 1667% increase overall (n = 45-795). Similarly, downloads, and presumably reads, increased 712% following prechat posts and another 47% bump after the chat, a 1093% increase overall (n = 394-4700). We tallied 181 potential solutions to the eight gender equity-related questions. Conclusion: Our results demonstrate that social media can be used strategically to increase the dissemination of research articles and collect solution-focused feedback.

Internal medicine trainees' knowledge and confidence in using the American Society of Hematology Choosing Wisely guidelines in hemostasis, thrombosis, and non-malignant hematology.

BACKGROUND: Several specialty societies participate in the Choosing Wisely (CW) campaign in an attempt to reduce waste in health care spending. We surveyed internal medicine (IM) residents with an objective of classifying knowledge of and confidence in using the American Society of Hematology (ASH) CW principles in hemostasis, thrombosis, and non-malignant hematology. METHODS: Multi-institutional study of IM residents at 5 academic training programs in the United States. A 10-question, case-based multiple choice test, with each question accompanied by a 5-point Likert-scale confidence assessment, was distributed electronically. Responses were summarized with frequencies and percentages or medians and ranges, as appropriate. Two sample t-tests or Wilcoxon rank-sum tests were used to compare confidence and knowledge scores. RESULTS: Of 892 IM residents, 174 (19.5%) responded to all questions. Overall, residents answered a median of 7 of 10 questions correctly (range 2-10) and median resident confidence in their responses was 3.1 (on a 5-point scale). Correct responses were significantly associated with higher confidence for all but one question. Having a hematology rotation experience was significantly associated with more correct responses and with higher confidence (p = 0.001 and p<0.001, respectively). CONCLUSIONS: IM residents at several academic hospitals have variable knowledge of ASH-CW guidelines in thrombosis and hemostasis/non-malignant hematology. Residents who have done hematology rotations, particularly a hematology consult rotation, were more likely to answer questions correctly and to be more confident that their answers were correct. Adequate clinical exposure and training in cost-effective care is essential to train clinicians who are cost-conscious in any specialty.

Helicobacter pylori: The Past, Present, and Future in Management.

Helicobacter pylori is a common bacterial pathogen responsible for substantial gastrointestinal morbidity worldwide. Helicobacter pylori infection can be clinically challenging, given the numerous diagnostic and therapeutic options available. In this article, we provide a systematic review of H pylori epidemiology and pathogenesis. In addition, we provide a simplified approach to the diagnosis and treatment of H pylori infection, suitable for application in the primary care setting. On completion of this article, one should be able to (1) state the indications for H pylori testing; (2) identify noninvasive and invasive tests to diagnose H pylori infection; and (3) describe the advantages and disadvantages of various treatment regimens.

Training in small-bowel capsule endoscopy: assessing and defining competency.

BACKGROUND: Minimum training for capsule endoscopy (CE) is based on societal guidelines and expert opinion. Objective measures of competence are lacking. OBJECTIVES: Our objectives were to (1) establish structured CE training curriculum during a gastroenterology fellowship, (2) develop a formalized assessment tool to evaluate CE competency, (3) prospectively analyze trainee CE competency, (4) define metrics for trainee CE competence by using comparative data from CE staff, and (5) determine the correlation between CE competence and previous endoscopy experience. DESIGN: Single-center, prospective analysis over 6 years. SETTING: Tertiary academic center. SUBJECTS: Gastroenterology fellows and CE staff. INTERVENTIONS: Structured CE training was implemented with supervised CE interpretation. Capsule Competency Test (CapCT) was developed and data were collected on the number of CEs, upper endoscopies, colonoscopies, and push enteroscopies performed. MAIN OUTCOME MEASUREMENTS: Trainee competence defined as CapCT score 90% or higher of the mean staff score. RESULTS: A total of 39 fellows completed CE training and CapCT. Fellows were grouped according to number of completed CE interpretations: 10 or fewer (n = 13), 11 to 20 (n = 19), and 21 to 35 (n = 7). Eight CE staff completed CapCT with a mean score of 91%. Mean scores for trainees with fewer than 10, 11 to 20, and 21 to 35 CE interpretations were 79%, 79%, and 85%, respectively. A significant difference was seen between staff and fellow scores with 10 or fewer and 11 to 20 interpretations (P < .001). No correlation was found between trainee scores and previous endoscopy experience. LIMITATIONS: Single center. CONCLUSION: Using a structured CE training curriculum, we defined competency in CE interpretation by using the CapCT. Based on these findings, trainees should complete more than 20 CE studies before assessing competence, regardless of previous endoscopy experience.

Mentorship programs for gastroenterology program directors: is there an unmet need?

GOALS: The purpose of this study was to determine whether a need exists for mentorship programs among gastroenterology (GI) fellowship program directors (PDs), to investigate specific areas where mentoring would be helpful, and to assess the willingness to establish mentoring relationships. BACKGROUND: There is no research regarding mentorship for GI fellowship PDs or associate/assistant program directors (APDs). Although some mentoring resources currently exist, it is not clear whether they fulfill the needs of PDs and APDs. STUDY: Mentorship needs were assessed using an electronic survey sent to GI PDs and APDs who subscribe to the American Gastroenterological Association PDs' list server. RESULTS: Fifty-nine GI PDs (47.6% completion rate) and 18 APDs returned the survey. Seventy-five percent of PDs and 78% of APDs thought a formal mentorship program would be beneficial to those starting their role. Content areas were identified where a mentor would be most helpful included Accreditation Council for Graduate Medical Education competencies, accreditation requirements, curriculum development, and site visit preparation. CONCLUSIONS: Current GI PDs and APDs felt a mentoring program would be beneficial, despite the availability of several resources including web sites and meetings. Our results suggest that there remains an unmet need for mentorship resources among GI PDs and APDs.

Factors predicting initial career choices in gastroenterology fellows.

BACKGROUND AND GOALS: As academic gastroenterology (GI) fellowship programs often gear trainee recruitment to those displaying potential for academic careers, the aim of the study was to determine whether predictive factors exist that determine whether GI fellows pursue academia versus private practice. STUDY: Educational file review was conducted on all GI fellows from Mayo Clinic-Rochester from 1990 through 2003, with demographic variables extracted. The outcome of interest was whether the first job after fellowship was in academics or private practice. RESULTS: Of 92 fellows completing training, 60 accepted academic positions (65%) (P=0.005, 95% confidence interval: 0.55-0.74), whereas 32 (35%) pursued private practice. Those of Asian descent were significantly more likely to enter academics versus those of African American (P=0.02) or Hispanic (P=0.01) descent. There were nonsignificant trends of more women than men (85% vs. 62%), military than non-military (86% vs. 63%), bachelors of arts than science degrees (70% vs. 50%) and advanced fellowship training than not (74% vs. 61%) going into academics. There was no significant difference in career choices between fellows entering the National Institutes of Health training tract versus the Clinical Scholar or Clinical Investigator tracts. There were no significant associations between age, marital status, hometown population, foreign medical degree, research mentor factors or type of research during fellowship and practice choice. CONCLUSIONS: Although there seem to be predictive variables in determining whether GI fellows enter private practice or academia, the initial practice choice likely results from multiple combined factors.