Historical Inequities in Medical Education - Commitment to Opportunity, Diversity, and Equity at the University of Hawai'i School of Medicine.

Medical education in the US has contributed to institutionalized racism through historically exclusionary practices, which has led to health disparities and inequities in health care today. The 1910 Flexner report, which favored schools with greater resources, led to the closure of nearly half of medical schools in the Us, which were mostly small schools located in rural communities that served economically disadvantaged, ethnic minority, and female populations. Closing these schools ultimately limited the availability of physicians willing to serve disadvantaged and minority populations in impoverished and underserved communities. In order to transform medical education to be more equitable, medical schools must be proactive in opportunity, diversity, and equity efforts. This not only includes efforts in admissions and faculty hiring, but also curricula related to social and health disparities, interracial interactions between students and faculty, and service learning activities that engage and work with marginalized communities. The University of Hawai'i John A. Burns School of Medicine has a longstanding commitment to diversity, which is integral to the school's mission. Providing opportunities to underserved populations has been a priority since establishment of the school. As one of the most diverse univeristies in the US, the school of medicine continues to focus on opportunity, diversity, and equity priorities in both its strategic planning and overall mission.

Assessment by mini clinical evaluation exercise (Mini-CEX) in the intensive care unit.

INTRODUCTION: Mini Clinical Evaluation Exercise (mini-CEX) is one of the assessment tools in medical education. It includes three steps: overview of clinical situation, observation and feedback. AIM: To evaluate the feasibility of mini-CEX as a formative assessment tool for medical trainees in 5th year of medicine in a teaching intensive care unit (ICU). METHODS: Single-center qualitative research conducted in ICU during the 2nd semester of the academic year 2022-2023. Seven core clinical skill assessments were done, and the performance was rated on a 9-point scale. An assessment of the method was conducted with both trainees and clinical educators. RESULTS: We conducted six mini-CEX recorded sessions. All medical students had marks under the average of 4.5. In the first period, the highest mark was obtained for counselling skills (4.5). The best score was obtained for clinical judgement (4) in the second period and for management plan (4) in the third period. Most of medical trainees (11 sur 12) were satisfied with the method and feedback was according to them the most useful step. Ten students agreed fully to introduce this assessment tool in medical educational programs. Two medical educators out of three did not practice this method before. They agreed to include mini-CEX in the program of medical education of the faculty of medicine of Tunis. However, they did not agree to use it as a summative assessment tool. CONCLUSION: Our study demonstrates that we can use the mini-CEX in medical teaching. Both trainees and educators were satisfied with the method.

[Open educational resources for otorhinolaryngology : A pilot study on needs assessment and implementation]. / Open Educational Resources für die HNO-Heilkunde : Ein Pilotprojekt zur Bedarfsanalyse und Implementierung.

BACKGROUND: Open educational resources (OER) are educational materials licensed openly by authors, permitting usage, redistribution, and in some instances, modification. OER platforms thereby serve as a medium for distributing and advancing teaching materials and innovative educational methodologies. OBJECTIVE: This study aims to determine the present state of OER in otorhinolaryngology and to examine the prerequisites for seamlessly integrating OER into the curricular teaching of medical schools, specifically through the design of two OER blended learning modules. METHODS: OER content in the field of otorhinolaryngology was analyzed on OER platforms, ensuring its relevance to the German medical curriculum. Data protection concerns were addressed with legal counsel. The blended learning modules were developed in collaboration with medical students and subsequently published as OER. RESULTS AND CONCLUSION: This project yielded the first OER from a German ENT department, tailored to the German medical curriculum. One significant barrier to OER use in medicine, more than in other fields, is data protection. This challenge can be navigated by obtaining consent to publish patient data as OER. OER hold the promise to play a pivotal role in fostering cooperation and collaboration among educators, aiding educators in lesson preparation, and simultaneously enhancing didactic quality.

Design and Implementation of a National Program of Assessment Model - Integrating Entrustable Professional Activity Assessments in Canadian Specialist Postgraduate Medical Education.

Traditional approaches to assessment in health professions education systems, which have generally focused on the summative function of assessment through the development and episodic use of individual high-stakes examinations, may no longer be appropriate in an era of competency based medical education. Contemporary assessment programs should not only ensure collection of high-quality performance data to support robust decision-making on learners' achievement and competence development but also facilitate the provision of meaningful feedback to learners to support reflective practice and performance improvement. Programmatic assessment is a specific approach to designing assessment systems through the intentional selection and combination of a variety of assessment methods and activities embedded within an educational framework to simultaneously optimize the decision-making and learning function of assessment. It is a core component of competency based medical education and is aligned with the goals of promoting assessment for learning and coaching learners to achieve predefined levels of competence. In Canada, postgraduate specialist medical education has undergone a transformative change to a competency based model centred around entrustable professional activities (EPAs). In this paper, we describe and reflect on the large scale, national implementation of a program of assessment model designed to guide learning and ensure that robust data is collected to support defensible decisions about EPA achievement and progress through training. Reflecting on the design and implications of this assessment system may help others who want to incorporate a competency based approach in their own country.

Anti-racism bystander training: A critical need in medical schools.

Despite increasing acknowledgment of racism in both the curricular and clinical spaces, it continues to pervade the medical field, with clear detrimental impacts to the health of our patients. The introduction of anti-racism bystander training (ARBT) may provide a unique opportunity to reduce inequitable care and health disparities that occur secondary to racism in healthcare. ARBT, in its various forms, has been shown to be an effective method to increase participants' confidence and efficacy in intervening on observed racist encounters. This training can take numerous forms, and the authors provide one successful template used with medical students at their own institution. If medical centers, educators, and leaders in the field of medicine truly hope to mitigate the individual racist behaviors that remain in healthcare, ARBT must be employed to a much wider degree in medical education.

The Promise and Perils of Artificial Intelligence in Health Professions Education Practice and Scholarship.

ABSTRACT: Artificial intelligence (AI) methods, especially machine learning and natural language processing, are increasingly affecting health professions education (HPE), including the medical school application and selection processes, assessment, and scholarship production. The rise of large language models over the past 18 months, such as ChatGPT, has raised questions about how best to incorporate these methods into HPE. The lack of training in AI among most HPE faculty and scholars poses an important challenge in facilitating such discussions. In this commentary, the authors provide a primer on the AI methods most often used in the practice and scholarship of HPE, discuss the most pressing challenges and opportunities these tools afford, and underscore that these methods should be understood as part of the larger set of statistical tools available.Despite their ability to process huge amounts of data and their high performance completing some tasks, AI methods are only as good as the data on which they are trained. Of particular importance is that these models can perpetuate the biases that are present in those training datasets, and they can be applied in a biased manner by human users. A minimum set of expectations for the application of AI methods in HPE practice and scholarship is discussed in this commentary, including the interpretability of the models developed and the transparency needed into the use and characteristics of such methods.The rise of AI methods is affecting multiple aspects of HPE including raising questions about how best to incorporate these models into HPE practice and scholarship. In this commentary, we provide a primer on the AI methods most often used in HPE and discuss the most pressing challenges and opportunities these tools afford.

Comparing ChatGPT's ability to rate the degree of stereotypes and the consistency of stereotype attribution with those of medical students in New Zealand in developing a similarity rating test: a methodological study.

Learning about one's implicit bias is crucial for improving one's cultural competency and thereby reducing health inequity. To evaluate bias among medical students following a previously developed cultural training program targeting New Zealand Maori, we developed a text-based, self-evaluation tool called the Similarity Rating Test (SRT). The development process of the SRT was resource-intensive, limiting its generalizability and applicability. Here, we explored the potential of ChatGPT, an automated chatbot, to assist in the development process of the SRT by comparing ChatGPT's and students' evaluations of the SRT. Despite results showing non-significant equivalence and difference between ChatGPT's and students' ratings, ChatGPT's ratings were more consistent than students' ratings. The consistency rate was higher for non-stereotypical than for stereotypical statements, regardless of rater type. Further studies are warranted to validate ChatGPT's potential for assisting in SRT development for implementation in medical education and evaluation of ethnic stereotypes and related topics.

Exposing the disability-related hidden curriculum in case-based learning: A qualitative study.

BACKGROUND: People with disabilities face significant health disparities. Studies show that healthcare professionals harbor negative attitudes towards disability, compromising the quality of care. These attitudes, in unwritten, unofficial, and even unintended ways can be passed from providers to learners in the medical education setting. OBJECTIVE: Using a Critical Disability Studies (CDS) paradigm, the authors uncovered the disability-related hidden curriculum within Case-Based Learning (CBL) and proposed guidelines for promoting a disability-conscious medical education that resists ableism. METHODS: The study team conducted a qualitative analysis of all CBL cases from the pre-clerkship curriculum (n = 53) at Sidney Kimmel Medical College. The authors employed a directed content analysis approach to develop a codebook based on case examination, literature review, and CDS concepts. Two researchers coded all cases and assessed intercoder reliability. The results informed the development of an explanatory model. RESULTS: Only four of 53 cases overtly mentioned disability, none of which defined disability according to CDS. Coding did not identify content challenging stereotypical views of disability. Additionally, two cases included content fueling negative attitudes of disability. CONCLUSION: By inadequately addressing disability from a CDS perspective, harmful assumptions of disability may go unchallenged, driving a hidden curriculum within CBL. This phenomenon leaves medical students ill-prepared to care for people with disabilities and creates physicians ill-equipped to teach the next generation. Since many health professions utilize CBL to educate students, these cases provide an untapped opportunity to resist ableism and better prepare students to address the negative attitudes driving health disparities experienced by people with disabilities.

Scale to measure medical, nursing and midwifery students' engagement in an e-learning histology course / Escala para medir la participación de estudiantes de medicina, enfermería y obstetricia en un curso de histología e-learning

SUMMARY: E-learning courses become increasingly important and relevant in medicine and health sciences over the last decade. However, there are few teaching experiences of e-learning histology courses published in the literature worldwide. Moreover, most of these studies focus on the didactic aspects of the course without exploring student participation. The study presented below aimed to validate a scale to measure student participation in an e-learning histology course. We provide evidence of validity of the instrument based on its internal structure for use with medical, nursing, and midwifery students. The participants in this study were a group of 426 Chilean medical, nursing and midwifery students from a public university who completed the questionnaire in two consecutive semesters (2020-2021). Data from the first group of students were used to perform an exploratory factor analysis (EFA), while data from the second group of participants were used to perform a confirmatory factor analysis (CFA). The three factors identified according to the CFA were: "Habits of online," "Motivation for online learning," and "Interaction of online". After eliminating one of the initial items of the instrument, the scale showed acceptable psychometric properties suggesting that it is a useful instrument to measure students' perception of their participation in e-learning histology courses. The factors identified through the validation of the instrument provide relevant information for teachers and curriculum developers to create and implement different ways of encouraging student participation in e- learning histology courses to support online learning.

Los cursos e-learning han tomado mayor importancia y relevancia durante la ultima década en carreras de medicina y ciencias de la salud. No obstante, existen escasas experiencias docentes de cursos de histologia e-learning publicadas en la literatura mundial. Además, la mayoría de estos estudios se centran en los aspectos didácticos del curso sin explorar la participación de los estudiantes. El estudio que presentamos a continuación tuvo por objetivo validar una escala para medir la participación de los estudiantes en un curso de histología e-learning. Aportamos evidencia de validez del instrumento basada en su estructura interna para su uso con estudiantes de medicina, enfermería y obstetricia. Los participantes de este estudio fueron un grupo de 426 estudiantes chilenos de medicina, enfermería y obstetricia de una universidad pública quienes completaron el cuestionario en dos semestres consecutivos (año 2020-2021). Los datos del primer grupo de estudiantes se utilizaron para realizar un análisis factorial exploratorio (AFE), mientras que los datos del segundo grupo de participantes se utilizaron para realizar un análisis factorial confirmatorio (AFC). Los tres factores identificados según el AFC fueron: "Hábitos de los estudiantes en línea", "Motivación por el aprendizaje en línea", "Interacción de los estudiantes en línea". Luego de la eliminación de uno de los ítems iniciales del instrumento, la escala mostró propiedades psicométricas aceptables sugiriendo que es un instrumento útil para medir la percepción de los estudiantes sobre su participación en cursos de histología en formato e-learning. Los factores identificados mediante la validación del instrumento entregan información relevante para que los profesores y curriculistas desarrollen e implementen diferentes formas de estimular la participación de los estudiantes en cursos de histología e- learning y así apoyar el aprendizaje en formato online.

Personal Financial Wellness Curricula for Medical Trainees: A Systematic Review.

PURPOSE: Education debt, poor financial literacy, and a late start to retirement savings can cause financial stress among physicians. This systematic review identifies methods for curriculum development, methods for curriculum delivery, and outcome measures to evaluate the effectiveness of personal financial wellness curricula for medical students, residents, and fellows. METHOD: The authors searched the Embase, MEDLINE (via EBSCO), Scopus, Education Resources Information Center (via EBSCO), and Cochrane Library databases and MedEdPORTAL (via PubMed) on July 28, 2022. Studies must have reported the outcome of at least 1 postcourse assessment to be included. RESULTS: Of the 1,996 unique citations identified, 13 studies met the inclusion criteria. Three curricula (23.1%) were designed for medical students, 8 (61.5%) for residents, 1 (7.7%) for internal medicine fellows, and 1 (7.7%) for obstetrics-gynecology residents and fellows. The most frequently discussed personal finance topics included student loans, investment options, disability insurance, life insurance, retirement savings, budgeting, debt management, and general personal finance. A median (interquartile range) of 3.5 (1.4-7.0) hours was spent on personal finance topics. Eleven curricula (85.6%) relied on physicians to deliver the content. Four studies (30.8%) reported precourse and postcourse financial literacy evaluations, each showing improved financial literacy after the course. Four studies (30.8%) assessed actual or planned financial behavior changes, each credited with encouraging or assisting with financial behavioral changes. One study (7.7%) assessed participants' well-being using the Expanded Well-Being Index, which showed an improvement after the course. CONCLUSIONS: Given the impact educational debt and other financial stressors can have on the wellness of medical trainees, institutions should consider investments in teaching financial literacy. Future studies should report more concrete outcome measures, including financial behavior change and validated measures of wellness.

A novel multimodal needs assessment to inform the longitudinal education program for an international interprofessional critical care team.

BACKGROUND: The current global pandemic has caused unprecedented strain on critical care resources, creating an urgency for global critical care education programs. Learning needs assessment is a core element of designing effective, targeted educational interventions. In theory, multimodal methods are preferred to assess both perceived and unperceived learning needs in diverse, interprofessional groups, but a robust design has rarely been reported. Little is known about the best approach to determine the learning needs of international critical care professionals. METHOD: We conducted multimodal learning needs assessment in a pilot group of critical care professionals in China using combined quantitative and qualitative methods. The assessments consisted of three phases: 1) Twenty statements describing essential entrustable professional activities (EPAs) were generated by a panel of critical care education experts using a Delphi method. 2) Eleven Chinese critical care professionals participating in a planned education program were asked to rank-order the statements according to their perceived learning priority using Q methodology. By-person factor analysis was used to study the typology of the opinions, and post-ranking focus group interviews were employed to qualitatively explore participants' reasoning of their rankings. 3) To identify additional unperceived learning needs, daily practice habits were audited using information from medical and nursing records for 3 months. RESULTS: Factor analysis of the rank-ordered statements revealed three learning need patterns with consensual and divergent opinions. All participants expressed significant interest in further education on organ support and disease management, moderate interest in quality improvement topics, and relatively low interest in communication skills. Interest in learning procedure/resuscitation skills varied. The chart audit revealed suboptimal adherence to several evidence-based practices and under-perceived practice gaps in patient-centered communication, daily assessment of antimicrobial therapy discontinuation, spontaneous breathing trial, and device discontinuation. CONCLUSIONS: We described an effective mixed-methods assessment to determine the learning needs of an international, interprofessional critical care team. The Q survey and focus group interviews prioritized and categorized perceived learning needs. The chart audit identified additional practice gaps that were not identified by the learners. Multimodal methods can be employed in cross-cultural scenarios to customize and better target medical education curricula.

Now Is the Time: A Primer on How to Be a Disability Education Champion in Your Medical School.

ABSTRACT: One in four noninstitutionalized adults in the United States lives with a disability. People with disabilities have frequent interactions with the medical community and the healthcare system yet experience disparities in access and outcomes. The Association of American Medical Colleges has included disability in its definition of diversity as one of the aspects of patient care that may affect health equity. However, training in the lived experience of disability is not always included in medical education. Physiatrists make excellent disability champions in medical schools, given their training and experience in the care of individuals with disabilities. Here, we describe strategies for physiatrists to increase disability education in medical schools and an overview of standards and tools (Liaison Committee on Medical Education standards; Commission on Osteopathic College Accreditation standards; International Classification of Functioning, Disability and Health language; and the Core Competencies on Disability for Health Care Education published by the Alliance for Disability in Health Care Education) physiatrists can use to facilitate interactions with medical school educational leadership. Specific examples are provided along with a framework to guide the development of disability champions in medical schools.

O pensamento político-pedagógico de Juan César García: Piaget-Gramsci-Freire e a formação profissional em Saúde na América Latina / The political and pedagogical thinking of Juan César García: Piaget-GramsciFreire and professional health education in América Latina / El pensamiento político-pedagógico de Juan César García: Piaget-GramsciFreire y la formación profesional en salud en América Latina

Neste artigo pretendo demonstrar a atualidade do pensamento político-pedagógico de Juan César García no contexto contemporâneo. Com esse objetivo, primeiro discuto a "teoria do modo de produção de médicos" proposta por García, inspirado no referencial marxista. Segundo, sistematizo elementos que permitem delinear uma teoria da educação baseada no materialismo-histórico, com forte influência do pensamento gramsciano, formulada por García em contraposição ao que chama de "pedagogia idealista". Terceiro, destaco na sua obra elementos político-pedagógicos que precisariam de melhor contextualização para poder avaliar sua efetiva contribuição para a educação profissional em Saúde. Finalmente, apresento argumentos que valorizam a contribuição de Juan César García para a compreensão da dialética permanência-transformação na relação educação-trabalho, sobretudo o papel das instituições encarregadas da formação de sujeitos críticos, criativos e engajados na luta histórica pela qualidade-equidade em saúde.(AU)

This article aims to demonstrate the political and pedagogical thinking of Juan César García from a contemporary perspective. First, I discuss the theory of the "mode of medical production" proposed by García, inspired by Marxism. Second, I systematize elements that delineate a theory of education based on historical materialism, with a strong influence from Gramscian thought as formulated by García, in contrast to what he calls "idealist pedagogy". Third, I highlight political and pedagogical elements in his work that need better contextualization to assess his real contribution to professional health education. Finally, I present arguments to highlight Juan César García's contribution to the understanding of the permanence-transformation dialectic in education-work relations, focusing on the role of institutions tasked with training critical and creative subjects engaged in the historic struggle for health equity and quality of care.(AU)

En este artículo, pretendo demostrar la actualidad del pensamiento político-pedagógico de Juan César García no contexto contemporáneo. Con ese objetivo, discuto primero la "teoría del modo de producción de médicos" propuesta por García, inspirado en el referencial marxista. Segundo, sistematizo elementos que permiten delinear una teoría de la educación basada en el materialismo-histórico, con fuerte influencia del pensamiento gramsciano, formulada por García en contraposición a lo que llama de "pedagogía idealista". Tercero, destaco en su obra elementos político-pedagógicos que necesitarían mejor contextualización para poder evaluar su efectiva contribución para la educación profesional en salud. Finalmente, presento argumentos que valorizan la contribución de Juan César García para la comprensión de la dialéctica permanencia-transformación en la relación educación-trabajo, principalmente el papel de las instituciones encargadas de la formación de sujetos críticos, creativos y comprometidos en la lucha histórica por la calidad-equidad en salud.(AU)

Low-cost peer-taught virtual research workshops for medical students in Pakistan: a creative, scalable, and sustainable solution for student research.

BACKGROUND: Pakistan has not been a major contributor to medical research, mainly because of the lack of learning opportunities to medical students. With the increase in online learning systems during COVID-19, research related skills can be taught to medical students via low-cost peer taught virtual research workshops. AIM OF THE STUDY: To assess the effectiveness of a comprehensive low-cost peer-taught virtual research workshops amongst medical students in Pakistan. METHODS: This quasi-experimental study assessed the effectiveness of five virtual research workshops (RWs) in improving core research skills. RWs for medical students from across Pakistan were conducted over Zoom by medical students (peer-teachers) at the Aga Khan University, Pakistan, with minimal associated costs. The content of the workshops included types of research, ethical approval and research protocols, data collection and analysis, manuscript writing, and improving networking skills for research. Improvement was assessed via pre-and post-quizzes for each RW, self-efficacy scores across 16 domains, and feedback forms. Minimum criteria for completion of the RW series was attending at least 4/5 RWs and filling the post-RW series feedback form. A 6-month post-RW series follow-up survey was also emailed to the participants. RESULTS: Four hundred medical students from 36 (/117; 30.8%) different medical colleges in Pakistan were enrolled in the RWs. However, only 307/400 (76.75%) medical students met the minimum requirement for completion of the RW series. 56.4% of the participants belonged to the pre-clinical years while the rest were currently to clinical years. The cohort demonstrated significant improvement in pre-and post-quiz scores for all 5 RWs (p <  0.001) with the greatest improvement in Data Collection and Analysis (+ 34.65%), and in self-efficacy scores across all domains (p <  0.001). 166/307 (54.1%) participants responded to the 6 months post-RWs follow-up survey. Compared to pre-RWs, Research involvement increased from 40.4 to 62.8% (p <  0.001) while proportion of participants with peer-reviewed publications increased from 8.4 to 15.8% (p = 0.043). CONCLUSION: Virtual RWs allow for a wide outreach while effectively improving research-related knowledge and skills, with minimal associated costs. In lower-middle-income countries, virtual RWs are a creative and cost-effective use of web-based technologies to facilitate medical students to contribute to the local and global healthcare research community.

The Resurgence of Medical Education in Sociology: A Return to Our Roots and an Agenda for the Future.

From 1940 to 1980, studies of medical education were foundational to sociology, but attention shifted away from medical training in the late 1980s. Recently, there has been a marked return to this once pivotal topic, reflecting new questions and stakes. This article traces this resurgence by reviewing recent substantive research trends and setting the agenda for future research. We summarize four current research foci that reflect and critically map onto earlier projects in this subfield while driving theoretical development elsewhere in the larger discipline: (1) professional socialization, (2) knowledge regimes, (3) stratification within the profession, and (4) sociology of the field of medical education. We then offer six potential future directions where more research is needed: (1) inequalities in medical education, (2) socialization across the life course and new institutional forms of gatekeeping, (3) provider well-being, (4) globalization, (5) medical education as knowledge-based work, and (6) effects of the COVID-19 pandemic.

Educating the Next Generation of Global Neurosurgeons: Competencies, Skills, and Resources for Medical Students Interested in Global Neurosurgery.

BACKGROUND: Global neurosurgery operates at the intersection of neurosurgery and public health. Although most global neurosurgery initiatives have targeted neurosurgeons and trainees, medical students represent the future of global neurosurgery. METHODS: A narrative review of the literature regarding research methodology, education, economics, health policy, health advocacy, relevant to global neurosurgery was conducted. RESULTS: We summarize pearls that all medical students interested in global neurosurgery should know. DISCUSSION: To become effective agents of change within global neurosurgery, medical students must master competencies of motivation, organization, collaborativeness, dependability, flexibility, resilience, creative problem-solving, ethical thinking, cultural humility, and global awareness and gain knowledge and skills regarding research, education, policy making, and advocacy. Discussions with neurosurgeons and trainees, neurosurgery interest groups, conferences, university global neurosurgery initiatives, and student organizations represent opportunities for learning and becoming involved in global neurosurgery.

Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education.

Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.