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1.
Acad Med ; 95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments): S136-S138, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33229957

RESUMEN

Recent data suggest that students from population groups that have been underrepresented in medicine are disproportionately excluded from admission into the national medical honor society, Alpha Omega Alpha (AΩA). This finding, in combination with increasing concerns about bias in medical student assessment, has led some medical schools to reexamine their AΩA selection process and/or their relationship with the organization. The Pritzker School of Medicine at the University of Chicago formed a task force to study the schools process of choosing students for recognition and to make recommendations regarding this issue.

2.
Acad Med ; 95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments): S51-S57, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32889920

RESUMEN

In 2015, the Pritzker School of Medicine experienced increasing student interest in the changing sociopolitical landscape of the United States and the interaction of these events with student and patient identity. To address this interest, an Identity and Inclusion Steering Committee was formed and formally charged with "providing ongoing direction for programs and/or curricula at Pritzker that support an inclusive learning environment and promote respectful and effective communication with diverse patients and colleagues around issues of identity." The authors describe this committee's structure and steps taken by the committee to create an inclusive community of students at Pritzker characterized by learning through civil discourse. Initiatives were guided by a strategy of continuous quality improvement consisting of regular iterative evaluation, ongoing school-wide engagement, and responsiveness to issues and concerns as they emerged. Data collected over the committee's 4-year existence demonstrate significant improvement in students' sense of inclusion and respect for different perspectives on issues related to identity, such as access to health care, racialized medicine, safe spaces, and nursing labor strikes. The authors discuss several principles that support the development of an inclusive community of students as well as challenges to the implementation of such programming. They conclude that a strategy of continuous quality improvement guided by values of social justice, tolerance, and civil discourse can build community inclusion and enhance medical training for the care of diverse patient populations.

3.
Acad Med ; 95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments): S1-S4, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32889924
4.
Acad Med ; 95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments): S66-S70, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32889938

RESUMEN

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.

5.
JAMA ; 323(20): 2022-2023, 2020 05 26.
Artículo en Inglés | MEDLINE | ID: mdl-32453348
6.
J Grad Med Educ ; 9(2): 241-244, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28439361

RESUMEN

BACKGROUND: Unprofessional behaviors undermine the hospital learning environment and the quality of patient care. OBJECTIVE: To assess the impact of an interactive workshop on the perceptions of and self-reported participation in unprofessional behaviors. METHODS: We conducted a pre-post survey study at 3 internal medicine residency programs. For the workshop we identified unprofessional behaviors related to on-call etiquette: "blocking" an admission, disparaging a colleague, and misrepresenting a test as urgent. Formal debriefing tools were utilized to guide the discussion. We fielded an internally developed 20-item survey on perception and participation in unprofessional behaviors prior to the workshop. An online "booster" quiz was delivered at 4 months postworkshop, and the 20-item survey was repeated at 9 months postworkshop. Results were compared to a previously published control from the same institutions, which showed that perceptions of unprofessional behavior did not change and participation in the behaviors worsened over the internship. RESULTS: Of 237 eligible residents, 181 (76%) completed both pre- and postsurvey. Residents perceived blocking an admission and the misrepresentation of a test as urgent to be more unprofessional at a 9-month follow-up (2.0 versus 1.74 and 2.63 versus 2.28, respectively; P < .05), with no change in perception for disparaging a colleague. Participation in unprofessional behaviors did not decrease after the workshop, with the exception of misrepresenting a test as urgent (61% versus 50%, P = .019). CONCLUSIONS: The results of this multi-site study indicate that an interactive workshop can change perception and may lower participation in some unprofessional behaviors.


Asunto(s)
Ética Médica , Medicina Interna/educación , Medicina Interna/ética , Internado y Residencia , Médicos/psicología , Mala Conducta Profesional , Humanos , Internado y Residencia/ética , Encuestas y Cuestionarios , Grabación en Video
9.
Acad Med ; 88(9): 1293-8, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23887003

RESUMEN

PURPOSE: Understanding the association between attending physicians' workload and teaching is critical to preserving residents' learning experience. The authors tested the association between attending physicians' self-reported workload and perceptions of time for teaching before and after the 2003 resident duty hours regulations. METHOD: From 2001 to 2008, the authors surveyed all inpatient general medicine attending physicians at a teaching hospital. To measure workload, they used a conceptual framework to create a composite score from six domains (mental demand, physical demand, temporal demand, effort, performance, frustration). They measured time for teaching using (1) open-ended responses to hours per week spent doing didactic teaching and (2) responses (agree, strongly agree) to the statement "I had enough time for teaching." They conducted multivariate logistic regression analyses, controlling for month, year, and clustering by attending physicians, to test the association between workload scores and time for teaching. RESULTS: Of 738 eligible attending physicians, 482 (65%) completed surveys. Respondents spent a median of three hours per week dedicated to teaching. Less than half (198; 43%) reporting enough time for teaching. The composite workload scores were normally distributed (median score of 15) and demonstrated a weak positive correlation with actual patient volume (r = 0.25). The odds of an attending physician reporting enough time for teaching declined by 21% for each point increase in composite workload score (odds ratio = 0.79 [95% confidence interval 0.69-0.91]; P = .001). CONCLUSIONS: The authors found that attending physicians' greater self-perceived workload was associated with decreased time for teaching.


Asunto(s)
Hospitales de Enseñanza/organización & administración , Internado y Residencia/organización & administración , Cuerpo Médico de Hospitales/organización & administración , Carga de Trabajo/estadística & datos numéricos , Recolección de Datos , Femenino , Humanos , Modelos Logísticos , Masculino
10.
Int Rev Psychiatry ; 25(3): 291-300, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23859092

RESUMEN

The utilization of competencies in medical education is relatively recent. In 1999 the United States Accreditation Council for Graduate Medical Education (ACGME) established six main competencies. Since then, the American Board of Psychiatry and Neurology have approved a specific list of competencies for their specialities in each of the ACGME's core competency areas. Assessment of competencies in both medical students and residents can be achieved through such methods as structured case discussion, direct observation, simulation, standardized patients, and 360-degree assessments, etc. Each assessment methodology has specific applications in the discipline of psychiatry. This paper reviews the different methods for assessing competencies with specific examples in psychiatric education. It is not intended as a comprehensive review of all assessment methods, but to provide examples and strategies to guide psychiatric educators in their practice. Students and residents were intentionally separated because there are differences in the teaching goals and objectives, and thus in the assessment purposes and design. Students are general, undifferentiated physicians-in-training who need to learn about psychiatric nosology, examinations, and treatment. Residents are mental health professionals who need more in-depth supervision in order to hone skills in all the specialized areas that arise in psychiatric practices, making supervision a vital part of residency programs.


Asunto(s)
Educación Médica/normas , Evaluación Educacional/normas , Competencia Profesional/normas , Psiquiatría/educación , Humanos
11.
J Hosp Med ; 8(7): 386-9, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23780912

RESUMEN

BACKGROUND: Unprofessional behavior can compromise care and detract from the hospital learning environment. Discrepancy between professional behaviors formally taught and what is witnessed has become increasingly evident. METHODS: With funding from the American Board of Internal Medicine Foundation, a workshop was developed to address unprofessional behaviors related to inpatient care previously identified in a multi-institution survey. The aims were to utilize video-based education to illustrate unprofessional behaviors, how faculty play a role in promoting such behaviors, and facilitate reflection regarding motivation for and prevention of these behaviors. Hospitalists and housestaff at 3 Chicago-area academic hospitals and 1 community teaching affiliate participated. Videos were debriefed, identifying barriers to professional behavior and improvement strategies. A postworkshop survey assessed beliefs on behaviors and intent to change practice. RESULTS: Forty-four (53%) faculty and 244 (68%) residents (postgraduate year 1 and greater) participated. The workshop was well received, with 89% reporting it "useful and effective." Two-thirds expressed intent to change behavior. Most (86%) believed videos were realistic and effective. Those who perceived videos as "very realistic" were more likely to report intent to change behavior (93% vs 53%, P = 0.01). CONCLUSIONS: Video-based education is a feasible way to promote reflection and address unprofessional behaviors among providers and may positively impact the learning environment.


Asunto(s)
Competencia Clínica/normas , Educación/normas , Médicos Hospitalarios/educación , Médicos Hospitalarios/normas , Internado y Residencia/normas , Grabación en Video/normas , Centros Médicos Académicos/métodos , Centros Médicos Académicos/normas , Educación/métodos , Tecnología Educacional/métodos , Tecnología Educacional/normas , Humanos , Grabación en Video/métodos
13.
Acad Med ; 88(1): 73-9, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23165272

RESUMEN

PURPOSE: Although the minority population of the United States is projected to increase, the number of minority students in medical schools remains stagnant. The University of Chicago Pritzker School of Medicine (PSOM) matriculates students underrepresented in medicine (URM) above the national average. To identify potential strategies through which medical schools can support the success of URM medical students, interviews with URM students/graduates were conducted. METHOD: Students/recent graduates (within six years) who participated in this study self-identified as URMs in medicine and were selected for participation using random quota sampling. Participants completed a semistructured, qualitative interview in 2009-2010 about their experiences at PSOM. Key themes were identified and independently analyzed by investigators to ensure intercoder agreement. RESULTS: Participants identified five facets of their medical school experiences that either facilitated or hindered their academic success. Facilitators of support clustered in three categories: the collaborative learning climate at PSOM, the required health care disparities course, and student body diversity. Inhibitors of support clustered in two categories: insufficiently diverse faculty; and expectations-from self and others-to fulfill additional responsibilities, or carry a disproportionate burden. CONCLUSIONS: Intentional cultivation of a collaborative learning climate, formal inclusion of health care disparities curriculum, and commitment to fostering student body diversity are three routes by which PSOM has supported URM students. Additionally, recognizing the importance of building a diverse faculty and extending efforts to decrease the disproportionate burden and stereotype threat felt by URM students are institutional imperatives.


Asunto(s)
Diversidad Cultural , Grupos Minoritarios/educación , Facultades de Medicina , Chicago , Femenino , Humanos , Entrevistas como Asunto , Masculino
14.
Acad Med ; 88(2): 265-8, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23269292

RESUMEN

PURPOSE: Physicians' exposure to pharmaceutical industry marketing raises concerns about their ability to make unbiased, evidence-based prescription decisions. This exposure begins early in medical education. The authors examined the frequency and context of such exposures for students before matriculation to medical school. METHOD: The authors distributed two separate but related questionnaires to all 389 students who matriculated at the University of Chicago Pritzker School of Medicine between 2007 and 2010. The survey inquired about interactions with the pharmaceutical industry before entering medical school. Descriptive statistics and Wilcoxon rank sum tests were used to analyze data. RESULTS: Across four years, 282 (72.5%) students responded to the first survey; 219 (56.3%) responded to the follow-up survey. The majority of those (62.1%) had interacted with or were exposed to pharmaceutical marketing before medical school. The most common interactions were accepting a pen (50.2%) and attending a sponsored lunch (37.9%), which occurred most commonly while shadowing (33.6% and 42.2%, respectively). The next most common interactions were receiving a small gift (24.7%) and attending a sponsored dinner (20.6%), which occurred most commonly in "other" contexts, such as through family and while working in a medical setting (48.2% and 48.9%, respectively). CONCLUSIONS: The majority of students had interacted with the pharmaceutical industry before medical school. The differences in context indicate that students enter medical school with a heterogeneous set of exposures to pharmaceutical marketing. Medical schools should consider interventions to enhance students' knowledge of the impact of pharmaceutical marketing on physicians' prescribing practices.


Asunto(s)
Conflicto de Intereses , Industria Farmacéutica/estadística & datos numéricos , Mercadotecnía/estadística & datos numéricos , Estudiantes Premédicos , Actitud , Chicago , Estudios Transversales , Humanos , Estudiantes Premédicos/psicología , Encuestas y Cuestionarios
17.
J Hosp Med ; 7(7): 543-50, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22592971

RESUMEN

BACKGROUND: Unprofessional behaviors undermine the hospital learning environment and quality of patient care. OBJECTIVE: To quantify perceptions of, and participation in, unprofessional behaviors among hospitalists. DESIGN: Observational survey study. SETTING: Three academic health centers. SUBJECTS: Hospitalists. MEASUREMENTS: Observation, participation in, and perceptions of unprofessional behaviors. RESULTS: Response rate was 76% (77/101). Nearly all behaviors were perceived as unprofessional ("unprofessional" or "somewhat unprofessional" on the Likert scale). Participation in egregious behaviors (ie, falsifying records) was low (<5%). The most frequent behaviors reported were having personal conversations in patient corridors (67.1%), ordering a test as "urgent" to expedite care (62.3%), and making fun of other physicians (40.3%). Four factors accounted for 76% of survey variance: (1) making fun of others; (2) learning environment (eg, texting during conferences); (3) workload management (eg, celebrating a blocked-admission); and (4) time pressure (eg, signing out work early). Hospitalists with less clinical time (<50% full-time equivalents [FTE]) were more likely to report making fun of others (ß = 0.94 [95% CI 0.32-1.56], P = 0.004). Younger hospitalists (ß = 0.87 [95% CI 0.07-1.67], P = 0.034) and those with administrative time (ß = 0.61 [95% CI 0.11-1.10], P = 0.017) were more likely to report participating in workload management behaviors. Hospitalists who work night shifts were more likely to report participating in time-pressure behaviors (ß = 0.67 [95% CI 0.17-1.17], P = 0.010). Workload management and learning environment varied by site. CONCLUSION: While hospitalist participation in unprofessional behaviors is low, job characteristics (clinical, administrative, nights), age, and site were associated with different types of unprofessional behavior that may affect the learning environment and patient care.


Asunto(s)
Participación de la Comunidad , Médicos Hospitalarios , Rol del Médico/psicología , Conducta Social , Identificación Social , Centros Médicos Académicos , Intervalos de Confianza , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Estados Unidos , Carga de Trabajo
18.
Am J Med ; 124(9): 806-12, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21854887

RESUMEN

Concerned with the quality of internal medicine training, many leaders in the field assembled to assess the state of the residency, evaluate the decline in interest in the specialty, and create a framework for invigorating the discipline. Although many external factors are responsible, we also found ourselves culpable: allowing senior role models to opt out of important training activities, ignoring a progressive atrophy of bedside skills, and focusing on lock-step curricula, lectures, and compiled diagnostic and therapeutic strategies. The group affirmed its commitment to a vision of internal medicine rooted in science and learned with mentors at the bedside. Key factors for new emphasis include patient-centered small group teaching, greater incorporation of clinical epidemiology and health services research, and better schedule control for trainees. Because previous proposals were weakened by lack of evidence, we propose to organize the Cooperative Educational Studies Group, a pool of training programs that will collect a common data set describing their programs, design interventions to be tested rigorously in multi-methodological approaches, and at the same time produce knowledge about high-quality practice.


Asunto(s)
Medicina Interna/educación , Internado y Residencia/organización & administración , Sociedades Médicas , Competencia Clínica , Curriculum/normas , Educación de Postgrado en Medicina/organización & administración , Fatiga/prevención & control , Reforma de la Atención de Salud/organización & administración , Humanos , Errores Médicos/prevención & control , Medicare Payment Advisory Commission , Objetivos Organizacionales , Relaciones Médico-Paciente , Política , Garantía de la Calidad de Atención de Salud/organización & administración , Mejoramiento de la Calidad/organización & administración , Integración de Sistemas , Estados Unidos , Tolerancia al Trabajo Programado
19.
Acad Med ; 85(10 Suppl): S76-80, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20881710

RESUMEN

BACKGROUND: Do perceptions of and participation in unprofessional behaviors change during internship? METHOD: Interns at three Chicago medicine residencies anonymously reported participation in unprofessional behaviors before and after internship. On the basis of a prior survey, interns rated 28 unprofessional behaviors from 1 (unprofessional) to 5 (professional). Site-adjusted regression examined changes in participation rates and perception scores. RESULTS: Response rates were 93% (105) before and 88% (99) after internship. Participation in on-call unprofessional behaviors increased ("blocking" admissions [12% versus 41%, P < .001], disparaging the ER [27% versus 45%, P = .005], misrepresenting tests as urgent to expedite care [40% versus 60%; P = .003], and signing out by phone [20% versus 42%, P < .001]). Participation in egregious behaviors (fraud, disrespect, misrepresentation) and perceptions of most behaviors remained unchanged. CONCLUSIONS: Although participation in egregious unprofessional behavior remained unchanged during internship, participation in on-call unprofessional behaviors increased.


Asunto(s)
Medicina Interna/educación , Medicina Interna/ética , Internado y Residencia/ética , Mala Conducta Profesional/ética , Adulto , Análisis de Varianza , Chicago , Femenino , Humanos , Modelos Logísticos , Masculino , Encuestas y Cuestionarios
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