Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment.

Problem: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. Intervention: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. Context: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. Impact: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners' awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. Lessons Learned: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.

The Development of a Comprehensive Mental Health Service for Medical Trainees.

Mental distress in medical learners and its consequent harmful effects on personal and professional functioning, a well-documented concern, draws attention to the need for solutions. The authors review the development of a comprehensive mental health service within a large and complex academic medical education system, created with special attention to offering equitable, accessible, and responsive care to all trainees. From the inception of the service in January 2017, the authors placed particular emphasis on eliminating obstacles to learners' willingness and ability to access care, including concerns related to cost, session limits, privacy, and flexibility with modality of service delivery. Development of outreach initiatives included psychoeducational programming, consultation services, and cultivation of liaison relationships with faculty and staff. Significant utilization of clinical services occurred in the first year of the program and increased further over the course of 4 academic years (2017-2021); with a 2.2 times increase in trainees served and a 2.4 times increase in visits annually. In the 2020-2021 academic year, 821 medical learners received services (for a total 5,656 visits); 30% of all medical students and 25% of house staff and fellows sought treatment in that year. In 2021, 38% of graduating medical school students and 27% of graduating residents and fellows had used mental health services at some point in their training. Extensive use of services combined with very high patient satisfaction ratings by medical learners within this system demonstrate the perceived value of these services and willingness to pursue mental health care when offered a resource that is cognizant of, and responsive to, their unique needs. The authors reflect on potential factors promoting utilization of services-institutional financial support, outreach efforts, and design of services to increase accessibility and reduce barriers to seeking treatment-and propose future areas for investigation.

Diversifying Faculty Leadership in Academic Medicine: The Program to Launch Underrepresented in Medicine Success (PLUS).

PLUS (Program to Launch Underrepresented in Medicine Success) is a 2-year cohort program at Indiana University School of Medicine providing professional development, funding and skills to produce scholarship, and a community to mitigate social and/or professional isolation for underrepresented in medicine (URiM) faculty. In year 1, scholars participate in leadership and professional development seminars and regular meetings with their mentor(s). They are assigned a PLUS Advisory Council advisor with whom they meet 2 to 3 times annually. In year 2, scholars participate in monthly seminars focused on research methods, writing productivity, and wellness. Additionally, scholars engage in a writing accountability group and practice reflective writing. Connections events, designed to combat isolation and cultivate community, occur monthly. At program completion, scholars complete a project resulting in a scholarly product for submission and dissemination in a peer-reviewed forum. To date, 3 cohorts, totaling 24 people, have participated: 20 (83%) Black, 4 (17%) Latinx; 12 (50%) females. Five scholars have completed the full program, whose pre- and postsurvey results are described. Program surveys demonstrate significant gains in scholars' confidence to secure leadership opportunities, connect with colleagues, and advocate for themselves and others. Scholars reported statistically significant increases in confidence to pursue leadership roles (t = -3.67, P = .02) and intent to submit their dossier for promotion (t = -6.50, P = .003). They were less likely to leave academic medicine (t = 2.75, P = .05) or pursue another academic appointment (t = 2.75, P = .05) after PLUS completion than at baseline. All scholars adequately met requirements for their third-year review (tenure track only), were promoted, or achieved tenure in less than 3 years since program completion. This article describes PLUS program objectives, evaluative components, and lessons learned during implementation, as a model to support URiM faculty at other institutions.

A competency-based approach to recruiting, developing, and giving feedback to department chairs.

Academic health centers (AHCs) are under unprecedented pressure, making strong leadership during these challenging times critical. Department chairs have tremendous influence in their AHCs, yet data indicate that--despite outstanding academic credentials--they are often underprepared to take on these important leadership roles. The authors sought to improve the approach to recruiting, developing, and giving feedback to department chairs at their institution, the Indiana University School of Medicine (IUSM), by reorganizing these processes around six key leadership competencies: leadership and team development, performance and talent management, vision and strategic planning, emotional intelligence, communication skills, and commitment to the tripartite mission. Over a two-year period (2009-2011), IUSM faculty and administrators developed standardized recruitment procedures to assess potential chairs based on the six leadership domains, and searches are now streamlined through centralized staff support in the dean's office. Additionally, IUSM offers a chair development series to support learning around these leadership competencies and to meet the stated professional development needs of the chairs. Finally, chairs receive structured feedback regarding their leadership (among other considerations) through two different assessment instruments, IUSM's Department Chair 360° Leadership Survey and IUSM's Faculty Vitality Survey--both of which the dean reviews annually. Strategically attending to the way that chairs are selected, developed, and given feedback has tremendous potential to increase the success of chairs and, in turn, to constructively shape the culture of AHCs.

Discussing the undiscussable with the powerful: why and how faculty must learn to counteract organizational silence.

Dialogue is essential for transforming institutions into learning organizations, yet many well-known characteristics of academic health centers (AHCs) interfere with open discussion. Rigid hierarchies, intense competition for resources, and the power of peer review in advancement processes all hamper difficult conversations, thereby contributing to organizational silence, and at great cost to the institution. Information necessary for critical decisions is not shared, individuals and the organization do not learn from mistakes, and diverse perspectives from those with less power are not entertained, or worse, are suppressed. When leaders become more skilled at inviting multiple perspectives and faculty more adept at broaching difficult conversations with those in power, differences are more effectively addressed and conflicts resolved. In this article, the authors frame why this skill is an essential competency for faculty and leaders alike and provide the following recommendations to institutions for increasing capacity in this area: (1) develop leaders to counteract organizational silence, (2) develop faculty members' skills in raising difficult issues with those in positions of power, and (3) train mentors to coach others in raising difficult conversations. The vitality of AHCs requires that faculty and institutional leaders develop relational communication skills and partner in learning through challenging conversations.

Practice-based learning and improvement in family medicine student clerkships: a CERA study.

BACKGROUND: Practice-based learning and improvement (PBLI) has been promoted as a key component of competency-based training in medical student education, but little is known about its implementation. METHODS: This project is part of a larger CERA omnibus survey of family medicine medical student clerkship directors carried out from July to September 2012. Analyses were conducted to assess clerkship infrastructure, learner assessment and feedback, and clerkship director perceptions of PBLI curricula. RESULTS: The majority (69.0%, 58/82) of family medicine clerkship directors reported that PBLI is not included in their clerkship. Significant predictors of PBLI in the curriculum include: regularly scheduled centralized teaching (weekly or more versus less than weekly, OR=1.14, 95% CI=1.01--1.29) and clerkship director belief that students should achieve PBLI competency (agree in competency versus disagree in competency, OR=1.19, 95% CI=1.08--1.30). Few (20.5%, 16/78) family medicine clerkship directors reported that the amount of PBLI in their curriculum is likely to increase in the next 12 months. The duration of the clerkship was a significant predictor of reported likelihood of increasing PBLI over the next 12 months (3 weeks versus 8 weeks, OR=1.23, 95% CI=1.00--1.51). CONCLUSIONS: Despite increased emphasis on quality improvement activities in practice, most family medicine clerkships do not currently offer PBLI curricula. Additionally, less than one in four family medicine clerkships plan on increasing the amount of PBLI curricula in the next 12 months. Continued research in this area is needed to identify successful models for PBLI curricular offerings.

An expanded model of faculty vitality in academic medicine.

Many faculty in today's academic medical centers face high levels of stress and low career satisfaction. Understanding faculty vitality is critically important for the health of our academic medical centers, yet the concept is ill-defined and lacking a comprehensive model. Expanding on previous research that examines vital faculty in higher education broadly and in academic medical centers specifically, this study proposes an expanded model of the unique factors that contribute to faculty vitality in academic medicine. We developed an online survey on the basis of a conceptual model (N = 564) and used linear regression to investigate the fit of the model. We examined the relationships of two predictor variables measuring Primary Unit Climate and Leadership and Career and Life Management with an overall Faculty Vitality index comprised of three measures: Professional Engagement, Career Satisfaction, and Productivity. The findings revealed significant predictive relationships between Primary Unit Climate and Leadership, Career and Life Management, and Faculty Vitality. The overall model accounted for 59% of the variance in the overall Faculty Vitality Index. The results provide new insights into the developing model of faculty vitality and inform initiatives to support faculty in academic medical centers. Given the immense challenges faced by faculty, now more than ever do we need reliable evidence regarding what sustains faculty vitality.

Flexibility in faculty work-life policies at medical schools in the Big Ten conference.

PURPOSE: Women lag behind men in several key academic indicators, such as advancement, retention, and securing leadership positions. Although reasons for these disparities are multifactorial, policies that do not support work-life integration contribute to the problem. The objective of this descriptive study was to compare the faculty work-life policies among medical schools in the Big Ten conference. METHODS: Each institution's website was accessed in order to assess its work-life policies in the following areas: maternity leave, paternity leave, adoption leave, extension of probationary period, part-time appointments, part-time benefits (specifically health insurance), child care options, and lactation policy. Institutions were sent requests to validate the online data and supply additional information if needed. RESULTS: Each institution received an overall score and subscale scores for family leave policies and part-time issues. Data were verified by the human resources office at 8 of the 10 schools. Work-life policies varied among Big Ten schools, with total scores between 9.25 and 13.5 (possible score: 0-21; higher scores indicate greater flexibility). Subscores were not consistently high or low within schools. CONCLUSIONS: Comparing the flexibility of faculty work-life policies in relation to other schools will help raise awareness of these issues and promote more progressive policies among less progressive schools. Ultimately, flexible policies will lead to greater equity and institutional cultures that are conducive to recruiting, retaining, and advancing diverse faculty.

Objective structured clinical exams: a critical review.

Since their inception in the 1970s, objective structured clinical examinations (OSCEs) have become popular and now are part of the US Medical Licensing Examination for all US medical graduates. Despite general acceptance of this method, there is debate over the value of OSCE testing compared to more traditional methods. A review of reliability and validity research does not clearly show superiority of OSCE testing. To use OSCEs in a valid and reliable way, attention must be paid to test content, test design, and implementation factors, especially when the results will be used for high-stakes decision making. While questions remain around the application of OSCE testing, there are also both known and hidden benefits to students, faculty, and organizations that use OSCEs. This paper reviews the pros and cons of the OSCE method and outlines important issues for medical educators to consider when planning to use OSCEs in their programs.