The Tea House Series: Striving Together to be Antiracist.

BACKGROUND: Though awareness of health care structures that are racist and oppressive is increasing among health care professionals, there is a gap in continuing education curricula focused on antiracist anti-oppressive practices, and limited faculty and staff development to guide individuals towards action. AIM: To develop, implement, and evaluate a novel antiracist faculty and staff development program called the Tea House Series. SETTING AND PARTICIPANTS: A five-part continuing education series with an accompanying online community for faculty and staff at the divisions of Hospital Medicine in one institution in the western United States. PROGRAM DESCRIPTION: The four foundational pillars integral to the Tea House Series were as follows: educational framework based on the pedagogy of Paulo Freire, local disparities data, welcoming space to establish a community of practice and accountability. Each session contained participant dialogue in small group activities. PROGRAM EVALUATION: Qualitative analysis of participant survey responses demonstrated transformation towards a hope to act with a sense of community. Quantitative analysis measured increased confidence for the program learning objectives. DISCUSSION: The Tea House Series may be used as a model for continuing education to provide the tools and the community to confront systems of racism and oppression in any institution.

Toward Creating Equity in Awards Received During Medical School: Strategic Changes at One Institution.

Membership in the Alpha Omega Alpha Honor Medical Society (AΩA) is a widely recognized achievement valued by residency selection committees and employers. Yet research has shown selection favors students from racial/ethnic groups not underrepresented in medicine (not-UIM). The authors describe efforts to create equity in AΩA selection at the University of California, San Francisco, School of Medicine, through implementation of a holistic selection process, starting with the class of 2017, and present outcomes.Informed by the definition of holistic review, medical school leaders applied strategic changes grounded in evidence on inclusion, mitigating bias, and increasing opportunity throughout the AΩA selection process. These addressed increasing selection committee diversity, revising selection criteria and training committee members to review applications using a new instrument, broadening student eligibility and inviting applications, reviewing blinded applications, and making final selection decisions based on review and discussion of a rank-ordered list of students that equally weighted academic achievement and professional contributions.The authors compared AΩA eligibility and selection outcomes for 3 classes (2014-2016) during clerkship metric-driven selection, which prioritized academic achievement, and 3 classes (2017-2019) during holistic selection. During clerkship metric-driven selection, not-UIM students were 4 times more likely than UIM students to be eligible for AΩA (P = .001) and 3 times more likely to be selected (P = .001). During holistic selection, not-UIM students were 2 times more likely than UIM students to be eligible for AΩA (P = .001); not-UIM and UIM students were similarly likely to be selected (odds ratio = .7, P = .12)This new holistic selection process created equity in representation of UIM students among students selected for AΩA. Centered on equity pedagogy, which advocates dismantling structures that create inequity, this holistic selection process has implications for creating equity in awards selection during medical education.

Identification of core objectives for teaching sustainable healthcare education.

BACKGROUND: Physicians will be called upon to care for patients who bear the burden of disease from the impact of climate change and ecologically irresponsible practices which harm ecosystems and contribute to climate change. However, physicians must recognize the connection between the climate, ecosystems, sustainability, and health and their responsibility and capacity in changing the status quo. Sustainable healthcare education (SHE), defined as education about the impact of climate change and ecosystem alterations on health and the impact of the healthcare industry on the aforementioned, is vital to prevention of adverse health outcomes due to the changing climate and environment. OBJECTIVE: To systematically determine which and when a set of SHE objectives should be included in the medical education continuum. DESIGN: Fifty-two SHE experts participated in a two-part modified-Delphi study. A survey was developed based on 21 SHE objectives. Respondents rated the importance of each objective and when each objective should be taught. Descriptive statistics and an item-level content validity index (CVI) were used to analyze data. RESULTS: Fifteen of the objectives achieved a content validity index of 78% or greater. The remaining objectives had content validity indices between 58% and 77%. The preclinical years of medical school were rated as the optimal time for introducing 13 and the clinical years for introducing six of the objectives. Respondents noted the definition of environmental sustainability should be learned prior to medical school and identifying ways to improve the environmental sustainability of health systems in post-graduate training. CONCLUSIONS: This study proposes SHE objectives for the continuum of medical education. These objectives ensure the identity of the physician includes the requisite awareness and competence to care for patients who experience the impact of climate and environment on health and advocate for sustainability of the health systems in which they work. ABBREVIATIONS: CVI: Content validity index; SHE: Sustainable healthcare education.

Practicing effectively in today's health system: teaching systems-based care.

BACKGROUND AND OBJECTIVES: The Institute of Medicine and the new Accreditation Council for Graduate Medical Education General Essentials have focused attention on the Undergraduate Medical Education for the 21st Century (UME-21) core content area of systems-based care. Through teaching systems-based care, medical students can learn how physicians effectively deliver and coordinate care within the health system. While medical students can be introduced to the organization, financing, and delivery of the health care system through lectures, the principles and practice of systems-based care must be reinforced through structured learning experiences during the clinical (ie, third and fourth) years. The purpose of this article is to define the undergraduate clinical content and experiences in systems-based care offered by the eight UME-21 partner schools. METHODS: The eight partner UME-21 schools exposed third- and fourth-year medical students to a variety of clinical experiences outside the traditional teaching hospital in such settings as physician offices, skilled nursing facilities, the patient's home, hospice, and public health departments. They also taught systems-based care skills such as care coordination, performance assessment, and quality improvement. RESULTS: Based on surveys of graduating students, the UME-21 programs were successful in exposing students to the aforementioned topics, though there was variability among schools. DISCUSSION: The experiences of the UME-21 schools in teaching about systems-based care, as discussed in this paper, may be useful to those involved in medical school curricula planning.