Building Equity, Inclusion, and Diversity Into the Fabric of a New Medical School: Early Experiences of the Kaiser Permanente Bernard J. Tyson School of Medicine.

In July 2020, the Kaiser Permanente Bernard J. Tyson School of Medicine opened in Pasadena, California, with an inaugural class of 50 students. The school endeavors to address systemic barriers that have contributed to health care and educational disparities in the United States. To realize its vision for change, equity, inclusion, and diversity (EID) have been woven throughout the school. Board members were chosen in part based on their commitment to the core values of EID. The board developed mission, vision, and values statements that explicitly avow a commitment to EID and recruited a dean (and the dean recruited leaders) who espoused and evinced these values. Leaders, faculty, and staff received training to foster an inclusive environment and ensure accountability. The school developed a curriculum that has been thoroughly evaluated for its representative and inclusive content by a team drawn from all departments. The diverse first class, selected through a holistic admissions approach, has access to student support systems that emphasize an appreciation of the distinct experiences and context of each student. The school plans a rigorous evaluation program to assess its performance in EID. Although the school may well fall short of achieving all of its EID objectives, by learning from its experiences and from evidence of others in academic medicine, the school recognizes its opportunity to continue to come closer to achieving its goals and to help shape and contribute to the national and international discourse on EID.

Transition to multiple mini interview (MMI) interviewing for medical school admissions.

INTRODUCTION: The multiple mini interview (MMI) has been incorporated into the holistic review process in the selection of students to US medical schools. The MMI has been used to evaluate interpersonal and intrapersonal attributes which are deemed as necessary for future physicians. We hypothesized that there would be little difference in overall MMI evaluation data compared with traditional interview ratings. METHODS: The University of North Carolina School of Medicine developed an interview process that included a traditional interview and MMI format during the 2019 admissions cycle. Evaluation data along with key demographic variables for 608 MD program applicants were analyzed using descriptive and inferential statistical analyses. RESULTS: The MMI format slightly favored female over male applicants (p = 0.002) but did not select for or against applicants based on age, race/ethnicity, underserved/rural area upbringing, or indicators of disadvantage. Out of 608 applicants, 356 (59%) completed a post-interview survey in which the experience was positively rated. DISCUSSION: Based on our experience, the use of a hybrid model of traditional interviews complemented with MMI stations provided greater details in the assessment of medical school applicants while obtaining equivalent data and acceptability amongst applicants.

Mindful medical practice: An innovative core course to prepare medical students for clerkship.

BACKGROUND: Medical students show a decline in empathy and ethical reasoning during medical school that is most marked during clerkship. We believe that part of the problem is that students do not have the skills and ways of being and relating necessary to deal effectively with the overwhelming clinical experience of clerkship. APPROACH: At McGill University in Montreal, starting in January 2015, we have taught a course on mindful medical practice that combines a clinical focus on the combination of mindfulness and congruent relating that is aimed at giving students the skills and ways of being to function effectively in clerkship. The course is taught to all medical students in groups of 20, weekly for 7 weeks, in the 6 months immediately prior to clerkship, a time when students are very open to learning the skills they need to take effective care of patients. EVALUATION: The course has been well accepted by students as evidenced by their engagement, their evaluations, and their comments in the essays that they write at the end of the course. In a follow-up session at the simulation centre one year later students remember clearly and enact what they were taught in the course. REFLECTION: The next steps will be to conduct a formal evaluation of the effect of our teaching that will involve a combination of qualitative methods to clarify the nature of the impact on our students and a quantitative assessment of the difference the course makes to students' experience and performance in clerkship.

Turning a blind eye and a deaf ear to traditional and complementary medicine practice does not make it go away: a qualitative study exploring perceptions and attitudes of stakeholders towards the integration of traditional and complementary medicine into medical school curriculum in Uganda.

BACKGROUND: A substantial proportion of healthcare professionals have inadequate understanding of traditional and complementary medicine and often consider their use inappropriate. METHODS: We conducted a qualitative study to understand the perceptions and attitudes of medical students, medical school faculty and traditional and complementary medicine practitioners. In-depth interviews and focus group discussions were used to collect data. Thematic approach was used in data analysis to identify emerging themes and sub themes. Data analysis was supported with use of Atlas.ti v6.1.1. RESULTS: The majority of participants commended the inclusion of traditional and complementary medicine principles into medical school curricula. The main reasons advanced were that: patients are already using these medicines and doctors need to understand them; doctors would be more accommodating to use and not rebuke patients, thereby minimizing delays in care due to pursuit of alternative therapies; promote patient safety; foster therapeutic alliance and adherence to therapy; uphold patients' right to self-determination; lead to discovery of new drugs from traditional medicines; and set ground for regulation of practices and quality control. However, participants anticipated operational and ethical challenges that include inadequate number of faculty to teach the subject, congested curricula, increased costs in research and development to produce evidence-base data, obstruction by pharmaceutical companies, inaccessibility to and depletion of medicinal plants, and potential conflicts due to diversity in culture and values. A substantial minority of participants thought traditional medicine need not be taught in medical schools because there is lack of scientific evidence on efficacy, safety, and side effects profiles. These shortfalls could make the determination of benefits (beneficence) and harm (maleficence) difficult, as well as compromise the ability of physicians to adequately disclose benefits and harms to patients and family, thereby undermining the process of informed consent and patient autonomy. CONCLUSIONS: Training medical students in principles of traditional and complementary medicine is considered reasonable, feasible, and acceptable; and could lead to improvement in health outcomes. There are anticipated challenges to implementing a hybrid medical school curricula, but these are surmountable and need not delay introducing traditional and complementary medicine principles into medical school curricula in Uganda.

China's private institutions for the education of health professionals: a time-series analysis from 1998 to 2012.

BACKGROUND: Public institutions have been the major provider of education for health professionals in China for most of the twentieth century. In the 1990s, the Chinese government began to encourage the establishment of private education institutions, which have been steadily increasing in numbers over the past decade. However, there is a lack of authoritative data on these institutions and little has been published in international journals on the current status of private education of health professionals in China. In light of this knowledge gap, we performed a quantitative analysis of private institutions in China that offer higher education of health professionals. METHODS: Using previously unreleased national data provided by the Ministry of Education of China, we conducted time-series and descriptive analyses to study the scale, structure and educational resources from 1998 to 2012 of private institutions for health professional education. RESULTS: The number of private institutions that educate health professionals increased from two in 1999 to 123 in 2012. Private institutions displayed an average annual growth rate of 44.2% for enrolment, 59.0% for the number of students and 53.3% for the number of graduates. In 2012, nursing, clinical medicine and traditional Chinese medicine had the most students (37.2%, 32.8% and 8.9% respectively), representing 78.9% of all students in these institutions. Ninety-seven private institutions located in the more economically advantaged eastern and central China and only 26 ones were in the less economically advantaged western China, respectively turning out 85.2% and 14.8% of health professional graduates. There were less educational resources, such as the number of faculty members, physical space and assets, at private institutions than at public institutions. CONCLUSIONS: Private institutions for the education of health professionals have emerged quickly in China, contributing to the demand for health professionals that exceeds what public institutions are able to offer. At the same time, the imbalance of geographical distribution and poor educational resources of private institutions are of concern. It may be of utmost importance to enhance administration and supervision to better regulate private institutions and their development plans. Future studies may be needed to better examine the effects of private institutions on the production and allocation of health workers.

Mudança curricular e de métodos pedagógicos: impacto vivenciado por estudantes de medicina / Curricular change and pedagogical methods: impact experienced by students of medicine

As mudanças nas formas de ensinar e aprender com ênfase no papel ativo dos estudantes têm sido observadas no Ensino Superior em geral e, em particular, no Ensino Médico. Apesar de haver um número considerável de trabalhos em torno dessa temática, constata-se uma carência relativa a estudos que valorizem a percepção dos estudantes como os agentes ativos de sua própria formação. Logo, com a finalidade de conhecer e analisar a qualidade das experiências vivenciadas, foi realizado um grupo focal com 6 estudantes concluintes do curso de Medicina de uma Faculdade Privada em Minas Gerais - Brasil no qual foram trabalhadas as suas percepções sobre as mudanças a nível do currículo, do curso e dos métodos pedagógicos dos professores, nomeadamente as alterações ocorridas nas vivências acadêmicas e adaptação. Importante destacar que os estudantes da pesquisa tiveram meios de comparação pela convivência com os colegas do curriculo antigo durante toda a formação. Os resultados mostraram que os estudantes foram capazes de identificar as alterações ocorridas no currículo e nos métodos pedagógicos; que os métodos ativos favoreceram qualitativamente as vivências acadêmicas por estreitar e melhorar as relações interpessoais com colegas de turma e de outras áreas, no trabalho interprofissional, além prepara-los melhor para a relação com o paciente. Quanto às atitudes e comportamentos adaptativos, relataram imaturidade, ansiedade e medo inerentes às novidades implementadas e aos cenários reais de prática no início do curso, demonstrando que os mesmos necessitam de apoios vários no processo de transição e adaptação.

Modifications in the teaching and learning methods, focusing an active role of the students, have been experienced in Higher Education, in general, and especially, in Medical Education. Although there is a reasonable number of studies around this issue, it is recognised a lack of studies that highlight the attitude of students as active agents of their own education. Therefore, aiming to understand and analyse the quality of the experiences, it was carried out a focus group with six senior students of Medicine of a Private University in Minas Gerais – Brazil. Herewith, were worked up students’ perceptions about the modifications in the syllabus, the course and in the teaching methods of the professors, namely the changes occurred in the academic experience and adjustment. Also, important to point out is that the students taking part in the research have had comparison means by getting together with peers from former syllabus during their instruction. Results show that the students were able to identify the changes carried out in the syllabus and in the teaching methods; that the active methods have boosted qualitatively the academic experiences and straitened and enhanced the interpersonal relationships with their peers and from other fields, at interprofessional work, besides preparing them better in their relationship with the patient. Regarding attitudes and adjustment behaviours, they have described immaturity, anxiety and fear resulting from the new things implemented and the real practice sceneries of the instruction proving that they need different support during the adjustment and transition process.

Why Do Students Engage in Elective Courses on Acupuncture and Homeopathy at Medical School? A Survey.

BACKGROUND: We aimed to investigate why medical students in Germany participate in elective courses on acupuncture or homeopathy. METHODS: The study was a nationwide, cross-sectional survey. Elective courses on acupuncture and homeopathy in the academic half-year 2013/14 were identified by inquiries directed to all 37 German medical schools, to student initiatives, and organizations supporting such courses. Participants of courses were asked to fill in a questionnaire consisting of a free-text question on their motives and closed questions regarding personal experiences, personal environment, evidence, role of the therapy as a complement to conventional medicine, and opportunistic aspects in relation to the therapy chosen. RESULTS: Students participating in 16 of 18 identified acupuncture courses (n = 220) and 12 of 13 identified homeopathy courses (n = 113) filled in the questionnaire. Content analysis of the free text showed that personal experience, a feeling that conventional medicine is somehow incomplete, the belief that acupuncture or homeopathy could help to overcome this shortcoming, and positive characteristics attributed to the therapies were the main motives for participation. Quantitative analyses showed that own experiences and considering the therapy a useful complement to conventional medicine were similarly rated motives in both groups, while opportunistic aspects played almost no role. The influence of the personal environment was more important among homeopathy students, while acupuncture students considered their therapy better backed by evidence. CONCLUSION: In our survey, personal experiences and the belief that acupuncture or homeopathy allows grasping the patient more holistically were primary motives for participation.

Team Player.

Stuart D. Flynn, MD, is the inaugural dean of the new Fort Worth allopathic medical school, a partnership of The University of North Texas Health Science Center and Texas Christian University.

How spirituality is understood and taught in New Zealand medical schools.

OBJECTIVES: The objective of this research was to explore how spirituality is currently understood and taught in New Zealand Medical Schools. METHODS: A mixed methods study was carried out involving interviews (n = 14) and a survey (n = 73). The first stage of the study involved recorded semi-structured interviews of people involved in curriculum development from the Dunedin School of Medicine (n = 14); which then informed a cross-sectional self-reported electronic survey (n = 73). RESULTS: The results indicate that spirituality is regarded by many involved in medical education in New Zealand as an important part of healthcare that may be taught in medical schools, but also that there is little consensus among this group as to what the topic is about. SIGNIFICANCE OF RESULTS: These findings provide a basis for further discussion about including spirituality in medical curricula, and in particular indicate a need to develop a shared understanding of what 'spirituality' means and how it can be taught appropriately. As a highly secular country, these New Zealand findings are significant for medical education in other secular Western countries. Addressing spirituality with patients has been shown to positively impact a range of health outcomes, but how spirituality is taught in medical schools is still developing across the globe.

Medicina de Familia como asignatura obligatoria en el grado de Medicina de la Universitat de Lleida: análisis de la percepción de los estudiantes / Family Medicine as a compulsory course in the Medicine degree at the University of Lleida: analysis of students' perceptions

Objetivo. Evaluar la percepción y la satisfacción respecto a la adquisición de competencias sobre la especialidad de Medicina de Familia y Comunitaria (MFyC) por parte de los estudiantes de pregrado matriculados en el primer año de instauración de la asignatura obligatoria de nuestra especialidad en la Facultad de Medicina de la Universitat de Lleida. Materiales y métodos. Estudio descriptivo transversal mediante encuesta anónima sobre la satisfacción respecto a la adquisición de competencias de la especialidad de MFyC y el cumplimiento de algunas de las competencias que forman parte de la asignatura. Se incluyó a los 107 alumnos matriculados que cumplimentaron la encuesta de satisfacción. Resultados. Los alumnos consideraron que la asignatura transmitía bien los conocimientos de MFyC, con una media de 7,96 ± 1,38 puntos, y que conseguía transmitir una visión integral del individuo respecto a la enfermedad, con 7,51 ± 1,75 puntos. La práctica asistencial obtuvo 9,0 ± 1,3 puntos y la valoración global de la asignatura, 7,03 ± 1,51. Las ocho competencias específicas obtuvieron 7,94 puntos de cumplimiento y las cuatro competencias transversales, una media de 7,95 puntos. Conclusiones. La enseñanza en el pregrado de MFyC ha cumplido las expectativas de los alumnos y ha logrado transmitir los conocimientos de las competencias asignadas (AU)

Aim. To evaluate undergraduate students' opinions of the compulsory course in Family and Community Medicine (FCM) in the bachelor's degree at the Faculty of Medicine, Lleida, and their satisfaction with the skills and knowledge acquired. Materials and methods. A descriptive, cross-sectional, anonymous survey of undergraduates' satisfaction with the skills and knowledge acquired in the FCM speciality. Results. The survey was completed by 107 students. Mean scores awarded were 7.96 ± 1.38 for the subject matter, 7.51 ± 1.75 for the holistic view provided of the individual with respect to disease, and 9.0 ± 1.3 for the practicals in patient care. The mean score for the overall assessment of the course was 7.03 ± 1.51. The eight specific skills were awarded a mean score of 7.94 and the four cross-sectional skills a mean score of 7.95. Conclusions. The course in FCM in the bachelor's degree in Medicine has met the expectations of students and provides a satisfactory overview of the skills required (AU)

An overview of the medical school admission process and use of applicant data in decision making: what has changed since the 1980s?

PURPOSE: To investigate current medical school admission processes and whether they differ from those in 1986 when they were last reviewed by the Association of American Medical Colleges (AAMC). METHOD: In spring 2008, admission deans from all MD-granting U.S. and Canadian medical schools using the Medical College Admission Test (MCAT) were invited to complete an online survey that asked participants to describe their institution's admission process and to report the use and rate the importance of applicant data in making decisions at each stage. RESULTS: The 120 responding admission officers reported using a variety of data to make decisions. Most indicated using interviews to assess applicants' personal characteristics. Compared with 1986, there was an increase in the emphasis placed on academic data during pre-interview screening. While GPA data were among the most important data in decision making at all stages in 1986, data use and importance varied by the stage of the process in 2008: MCAT scores and undergraduate GPAs were rated as the most important data for deciding whom to invite to submit secondary applications and interview, whereas interview recommendations and letters of recommendation were rated as the most important data in deciding whom to accept. CONCLUSIONS: This study underscores the complexity of the medical school admission process and suggests increased use of a holistic approach that considers the whole applicant when making admission decisions. Findings will inform AAMC initiatives focused on transforming admission processes.

Complementary medicine courses in Swiss medical schools: actual status and students' experience.

BACKGROUND: In line with growing public popularity of complementary and alternative medicine (CAM), courses in CAM have been implemented in Medical Schools internationally, but as yet in an uncoordinated and heterogeneous way. In Switzerland, comprehensive data about CAM education at Medical Faculties are lacking. OBJECTIVES: To survey courses at Swiss Medical Schools, document medical students' attitude toward and knowledge of CAM and their experience of CAM courses at medical schools. The aim was to determine the relationship between the presence/absence of CAM courses at each medical school and students' attitude toward, knowledge of, and motivation to learn about CAM. METHODS: Data about current courses in CAM were collected from the websites of the five Swiss Medical Schools and from an online questionnaire addressed to the CAM teachers (n = 13). All Swiss senior medical students (n = 640) were surveyed by an anonymous online questionnaire. RESULTS: There are two chairs for CAM in Bern and Zürich, CAM familiarisation courses are provided by external teachers in Basel and Lausanne, and there was no CAM education in Geneva. 38.3% of the senior medical students replied to the survey. 80.0% of the students who visited CAM courses stated that they have improved their knowledge of CAM. There was no relationship between the presence of CAM education and a significant elevation of the self-assessed knowledge of CAM of the students. CAM education has no significant influence on students' opinions about CAM, nor does it significantly motivate them to deepen their study of CAM. Form, frequency and content of CAM courses are similarly as heterogeneous as in other countries. CONCLUSIONS: There is no coordination or standard for CAM courses in Swiss Medical Schools. Our results suggest an overall positive attitude toward and positive personal experiences with CAM of Swiss medical students', but a relationship between the absence or presence of CAM courses and students attitudes and knowledge could not be found. A coordinated policy towards the integration of CAM in medical curricula is strongly recommended.

The status and future of osteopathic medical education in the United States.

Osteopathic medical education (OME) developed during the 20th century into a separate system of training U.S. physicians. Doctors of osteopathic medicine (DOs) were educated in osteopathic medical colleges and residencies in osteopathic hospitals, took separate specialty and licensure examinations, and generally practiced in separate clinical environments from those of MDs. Founded more than 110 years ago in the United States to train osteopaths as an alternative to MD training of that time, by midcentury schools of osteopathy became schools of osteopathic medicine with the adoption of public health and biomedical principles, and osteopaths became osteopathic physicians, achieving full practice rights throughout the country. By 2000 there were 19 osteopathic medical schools, 42,000 practitioners, and a parallel system of osteopathic graduate medical education specialty training. Recently, OME's academic and clinical training environment has changed. Heightened accreditation requirements, curriculum innovations, competency-based standards, evidence-based training, increased research on osteopathic manipulative medicine (a distinctive aspect of OME), and new and expanding colleges have occurred (nine new osteopathic campuses developed between 2000 and 2008 and a 30% increase in the first-year osteopathic medical student class). During recent decades, a movement away from osteopathic medicine's traditionally primary-care-focused and separate training/practice system has occurred. Nearly all osteopathic hospitals closed or were integrated into allopathic hospital systems, student clinical training expanded into venues with MD education programs, fewer DO graduates pursued traditional primary care training, 60% entered training programs of the Accreditation Council for Graduate Medical Education, and DO and MD specialty practice integration became widespread. These developments have triggered a reassessment process for OME and professional organizational leadership.