Using Accreditation to Transform Diversity, Equity, and Inclusion Efforts Into Diversity, Equity, and Inclusion Systems.

The Liaison Committee on Medical Education accreditation process is an important component of professional regulation and is used by medical schools to strengthen their medical education programs. Accreditation-related consultations with schools often include a review of relevant documents, stakeholder interviews, and mock site visits. A review by the author of this commentary of these consultations at 17 schools showed variability in how information regarding diversity, equity, and inclusion (DEI) was incorporated and discussed in accreditation-related materials and interviews. At all schools, DEI information emerged in materials related to the accreditation standards that specifically inquire into DEI. However, at some schools, DEI emerged more broadly across a variety of standards. These differences suggest that considering the totality of the Liaison Committee on Medical Education standards and elements may be a useful tool for enabling schools to analyze and describe their DEI efforts, consider additional ways to engage in continuous quality improvement related to DEI, and achieve institutional DEI goals. In addition, a small number of the reviewed schools appeared to have had particular success in meeting institutional DEI goals. An appreciative inquiry-informed review suggested that these exemplar schools had both area-specific and cross-functional systems focused on achieving DEI goals. In addition, senior leadership demonstrated a commitment to DEI, DEI champions were empowered, and leaders displayed legislative-style and systems leadership skills. Schools that nurture these characteristics may be better positioned to advance DEI. Scholarly evaluation of these observations is necessary.

Can Maintenance of Certification Work? Associations of MOC and Improvements in Physicians' Knowledge and Practice.

PURPOSE: To summarize the findings of studies, conducted by individuals both internal and external to the American Board of Medical Specialties (ABMS) Member Boards, of the associations of Maintenance of Certification (MOC) and improvements in physicians' knowledge and patient care processes or outcomes. METHOD: The authors conducted a narrative review of studies identified by searching PubMed and Web of Science for English-language articles from the United States published between 2000 and May 2017. To be included, articles had to examine the relationship of MOC to physician knowledge, clinical practice processes, or patient care outcomes. The initial search yielded 811 articles. After two rounds of review and excluding those articles that did not fit the study criteria, 39 articles were included for analysis. RESULTS: The 39 included studies were conducted by or included diplomates of 12 ABMS Member Boards. Twenty-two studies examined MOC processes that were developed by an ABMS Board; 17 examined interventions that were developed by nonboard entities but accepted for MOC credit by an ABMS Board. Thirty-eight studies examined a single component of MOC; 24 studied the improvement in medical practice component. Thirty-seven studies reported at least one positive outcome. CONCLUSIONS: Most of the studies included in this review highlighted circumstances in which MOC was associated with positive impacts on physician knowledge and patient care processes or outcomes. Future collaborative research is needed to improve the relevance, helpfulness, and generalizability of continuing certification to different physicians across specialties and practice settings.

Board Certification: Going Back to the Future.

The authors present snapshots of board certification in 1916, the year that the American Board of Ophthalmology was founded, 60 years later in 1976 as periodic recertification emerged, and speculation about what certification might look like in 2036. The concept of board certification and continuous certification in the medical specialties took shape at the beginning of the 20th century with the convergence of a new system of assessment, the emergence of certifying boards, and the creation of the American Board of Medical Specialties (ABMS). The importance of self-regulation is emphasized as are the principles underlying board certification and the standards that guide it to support its continued relevance as a valued credential and symbol of the highest standard in the practice of medicine.

The ABMS MOC Part III Examination: Value, Concerns, and Alternative Formats.

This article describes the presentations and discussions at a conference co-convened by the Council on Medical Education of the American Medical Association (AMA) and by the American Board of Medical Specialties (ABMS). The conference focused on the ABMS Maintenance of Certification (MOC) Part III Examination. This article, reflecting the conference agenda, covers the value of and evidence supporting the examination, as well as concerns about the cost of the examination, and-given the current format-its relevance. In addition, the article outlines alternative formats for the examination that four ABMS member boards are currently developing or implementing. Lastly, the article presents contrasting views on the approach to professional self-regulation. One view operationalizes MOC as a high-stakes, pass-fail process while the other perspective holds MOC as an organized approach to support continuing professional development and improvement. The authors hope to begin a conversation among the AMA, the ABMS, and other professional stakeholders about how knowledge assessment in MOC might align with the MOC program's educational and quality improvement elements and best meet the future needs of both the public and the physician community.

Expanding Educators' Contributions to Continuous Quality Improvement of American Board of Medical Specialties Maintenance of Certification.

The American Board of Medical Specialties board certification has transformed into a career-long process of learning, assessment, and performance improvement through its Program for Maintenance of Certification (MOC). Medical educators across many medical professional organizations, specialty societies, and other institutions have played important roles in shaping MOC and tailoring its overarching framework to the needs of different specialties. This Commentary addresses potential barriers to engagement in work related to MOC for medical school (MS) and academic health center (AHC) educators and identifies reasons for, and ways to accomplish, greater involvement in this work. The authors present ways that medical and other health professions educators in these settings can contribute to the continuous improvement of the MOC program including developing educational and assessment activities, engaging in debate about MOC, linking MOC with institutional quality improvement activities, and pursuing MOC-related scholarship. MS- and AHC-based educators have much to offer this still-young and continually improving program, and their engagement is sought, necessary, and welcomed.

Law, ethics, and the clinical neurologist.

There is dynamic interplay between the disciplines of law and ethics, and the result is often laws and regulation that impact the practice of clinical neurology. This chapter explores how the disciplines of law and ethics inform and intersect with each other, and how resulting law impacts the everyday work of the clinical neurologist. Examples of how the core bioethical principles of nonmaleficence, beneficence, respect for autonomy, and justice are manifest in legislative, common, and administrative laws are presented. Examples of how these laws, in turn, impact the practice of neurology through protection of patient privacy, the avoidance of conflict of interest, and informed consent and other issues are offered.

The 21st century faculty member in the educational process--what should be on the horizon?

One of Abraham Flexner's legacies was the concept of a professional faculty community responsible for teaching, scholarly work, and the creation and nurturing of the academic environment in medical schools. Dramatic shifts in society, health care, and educational practice have occurred over the century since Flexner's report, and these shifts have resulted in changes and challenges for medical school faculty. Fundamental principles that were articulated in Flexner's work remain relevant today: medicine is a profession, and as such is responsible for the education of the next generation of physicians; and the essential work of the medical school is the education of current and future generations of physicians. Medical schools must reconsider and restate the required characteristics and work of faculty members. Furthermore, we must develop a core faculty with primary responsibility for the educational program, the teaching of students, and the creation and nurturing of the academic environment. Enhancing the diversity of the faculty community, providing necessary faculty development, and further clarifying the forms of scholarly work in medicine are three ways that individual schools and national organizations can advance the educational mission through support of the faculty.

Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey.

OBJECTIVE: To determine medical students' perceptions of having been harassed or belittled and their correlates, for the purposes of reducing such abuses. DESIGN: Longitudinal survey. SETTING: 16 nationally representative US medical schools. PARTICIPANTS: 2884 students from class of 2003. MAIN OUTCOME MEASURES: Experiences of harassment and belittlement at freshman orientation, at entry to wards, and in senior year by other students, by residents or fellows, by preclinical professors, by clinical professors or attendings, or by patients. RESULTS: 2316 students provided data (response rate 80.3%). Among seniors, 42% (581/1387) reported having experienced harassment and 84% (1166/1393) belittlement during medical school. These types of abuse were caused by other students (11% (158/1389) and 32% (443/1390) of students experienced such harassment or belittlement, respectively). Harassment and belittlement was also caused by residents (27% (374/1387) and 71% (993/1393)), preclinical professors (9% (131/1386) and 29% (398/1385)), clinical professors (21% (285/1386) and 63% (878/1390)), and patients (25% (352/1387) and 43% (592/1388)). Only 13% (181/1385) of students classified any of these experiences as severe. Medical students who reported having been harassed or belittled did not differ significantly from those not reporting such experiences by sex, ethnicity, political orientation, or religion. They did differ significantly by chosen specialty and were significantly more likely to be stressed, depressed, and suicidal, to drink alcohol or to binge drink, and to state that their faculty did not care about medical students. They were also significantly less likely to be glad they trained to become a doctor. CONCLUSION: Most medical students in the United States report having been harassed or belittled during their training. Although few students characterised the harassment or belittlement as severe, poor mental health and low career satisfaction were significantly correlated with these experiences.

Stories from the field: students' descriptions of gender discrimination and sexual harassment during medical school.

PURPOSE: Previous studies have documented the prevalence of gender discrimination and sexual harassment during medical training, but very few have examined the behaviors that students perceive as discriminatory or harassing. The authors addressed this lack of information by examining graduating medical students' written descriptions of personal experiences with such behaviors during medical school. METHOD: The authors reviewed the responses of graduating seniors at 12 U.S. medical schools to a questionnaire, administered in 2001-02, that asked them to provide written descriptions of their personal experiences with gender discrimination and sexual harassment. Seven response categories were created on the basis of recurring themes: educational inequalities; stereotypical comments; sexual overtures; offensive, embarrassing, or sexually explicit comments; inappropriate touching; sexist remarks; and not classifiable. The three authors examined the students' written accounts and placed each into one or more of the categories. RESULTS: Of the students' responses, 290 (36.6%) contained 313 written descriptions of personal experiences that the students perceived as either discriminatory or harassing. The most frequently reported experiences involved educational inequalities; experiences in this category were reported more frequently by men than by women. All other categories of experiences were reported more frequently by women. CONCLUSIONS: The results support earlier findings of the prevalence of gender discrimination and sexual harassment during undergraduate medical education. Perhaps formal antiharassment policies should provide examples of unacceptable behavior that are based on categories such as those revealed by this analysis. Perhaps, too, medical students' comments could be used to develop educational interventions for physicians in supervisory positions.

Does students' exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection?

PURPOSE: To examine the role of gender discrimination and sexual harassment in medical students' choice of specialty and residency program. METHOD: Anonymous, self-administered questionnaires were distributed in 1997 to fourth-year students enrolled in 14 public and private U.S. medical schools. In addition to reporting the frequency of gender discrimination and sexual harassment encountered during preclinical coursework, core clerkships, elective clerkships, and residency selection, students assessed the impact of these exposures (none, a little, some, quite a bit, the deciding factor) on their specialty choices and rankings of residency programs. RESULTS: A total of 1,314 (69%) useable questionnaires were returned. Large percentages of men (83.2%) and women (92.8%) experienced, observed, or heard about at least one incident of gender discrimination and sexual harassment during medical school, although more women reported such behavior across all training contexts. Compared with men, significantly (p

Spirituality in medicine: a comparison of medical students' attitudes and clinical performance.

OBJECTIVE: The authors sought to examine attitudes about spirituality in medicine among medical students in psychiatric clerkships and determine whether instruction on concepts of spirituality in medicine had an effect on students' clinical performance in related tasks. METHODS: A total of 192 students entering psychiatric clerkships were randomly assigned to one of two groups; both groups received identical didactic instruction on spirituality in medicine. One group worked on a problem-based learning case that featured spirituality as a prominent theme, whereas the other group worked on problem-based learning cases that made no mention of it. Students completed pre- and posttest questionnaires, and their examination at the end of rotation included a standardized patient encounter requiring them to elicit a spiritual history. RESULTS: Among the 131 students who completed and returned both questionnaires, a significant difference (p=0.001) was noted between groups on students' self-reported knowledge of taking a spiritual history. However, students in the two groups received identical scores on the component of the examination requiring them to write a spiritual history. CONCLUSIONS: Although students who were exposed to material on spirituality in medicine reported greater understanding of the issue, no difference in clinical performance was observed.

Gender discrimination and sexual harassment in medical education: perspectives gained by a 14-school study.

PURPOSE: The authors attempted to determine male and female medical students' exposures to and perceptions of gender discrimination and sexual harassment (GD/SH) in selected academic and nonacademic contexts. METHOD: An anonymous, self-report questionnaire was administered in the spring of 1997 to senior medical students at 14 U.S. medical schools. Data were collected about students' exposures to GD/SH during undergraduate medical education and outside the medical training environment. Students' perceptions of GD/SH in various medical specialties and practice settings were also measured. RESULTS: Of the 1,911 questionnaires administered, 1,314 were completed (response rate, 69%). Both men and women reported exposures to GD/SH. More women than men reported all types of exposures to GD/SH across all academic and nonacademic contexts. Differences between men and women in the frequencies of exposures were greatest outside the medical training environment (t = 15.67, df = 1171, p