Leveraging Resident-As-Teacher Training for Health Equity Education: A Transformative Approach.

Issue: Resident teachers play an essential role in medical education and can support broader efforts to advance anti-racism and health equity in medicine. The Accreditation Council for Graduate Medical Education requires programs to provide education about health care disparities so residents can contribute to and lead work in this area. However, the literature includes few examples, frameworks, or strategies for preparing residents to develop the knowledge and skills needed to promote health equity, including in their role as clinical teachers. Evidence: In this article, the authors propose leveraging Resident-as-Teacher training to support residents in learning and teaching for health equity. Gorski's conceptualization of equity literacy provides an evidence-based framework for four main abilities (recognizing, responding, redressing, and cultivating/sustaining) residents and medical students can develop through co-learning about health equity in the clinical learning environment. The authors discuss preconditions, example activities, and assessments strategies for effective health equity education. Based on the principles of social learning theory, the authors recommend that Resident-as-Teacher training be part of an institutional strategy to cultivate a community of practice for health equity education. Implications: Incorporating health equity education into Resident-as-Teacher curriculum offers a potentially transformative part of the broader strategy needed to prepare the next generation of physicians to enact anti-racism and advance health equity.

I am an Educator: Investigating Professional Identity Formation using Social Cognitive Career Theory.

PhenomenonClinician-educators (CE) are physicians who fill a unique role within academic medicine, as they are responsible both for patient care and for training future physicians via teaching, curricular design, and creation of educational scholarship. Development of a strong professional identity as an educator leads to greater career satisfaction and a higher likelihood of staying in academic medicine. However, little is known about how this identity develops, especially in the training environment where there are competing pressures to develop as a clinician and researcher. This study aimed to explore professional identity formation in residents and fellows interested in becoming educators. Approach: We used a longitudinal, qualitative approach to investigate professional identity formation in residents and fellows participating in the Clinician-Educator Training Pathway. The longitudinal nature allowed us to temporally explore which aspects of the program and experiences acted as barriers or facilitators of professional identity formation as a CE. Our study used the social cognitive career theory (SCCT) Career Choice Model, which considers contextual influences in addition to the three variables of self-efficacy beliefs, outcome expectations, and goals. Findings: We found that participants shared a common goal of building self-efficacy as an educator. Participants took actions to engage more deliberately in formal and informal teaching and acting as an educator by giving learner feedback, developing curricula, and consuming and conducting educational research, all of which increased self-efficacy as educators. At the beginning of the program, participants were unclear of the roles and trajectories followed to become CEs. Engaging with a community of CEs clarified pathways and presented role models that could be seen as possible selves. This study also elucidated contextual influences relating to personal factors, career opportunities, and potential for advancement that mediated the goals and actions taken by participants to become educators. Insights: This study demonstrates that the SCCT Career Choice Model provides an excellent framework for understanding professional identity formation in future educators. Our participants built self-efficacy, formed outcome expectations, and set goals and took specific actions toward the goal of becoming an educator. Participants tested the various role model attributes as possible selves to see how those would be effective in their own career. Reflection on expectations, career goals, and self-efficacy as a clinician and an educator can assist in identity formation as a CE and can assist those designing CE training programs to better support identity formation in their participants.

Project management tools for healthcare education.

Health care education inherently requires managing projects, but few educators have the luxury of working with a project manager. In this article, we propose that applying project management theory to education work, and using project management software to organize our work, can improve our efficiency. We outline the approach project managers take to their work, which includes five steps: initiating, planning, executing, monitoring and controlling, and closing. We apply project management theory to the processes involved with health care education projects, and we describe the typical work that would be done at each step. We introduce readers to project management software, using one free program as an example. We provide examples of how we have used the software successfully. Finally, we provide suggestions for educators to use when selecting project management software.

Perspectives on Colon Cancer Screening-A Physician Panel Discussion for Preclinical Medical Students.

Introduction: Colon cancer is the third most common cancer in the US, and the survival rate improves drastically with early detection. It is important for medical students to understand screening options, and to be able to effectively discuss these options with their patients. While basic information about colon cancer screening is ubiquitous in US medical school curricula, no published curricula describe teaching students the nuances of negotiating this discussion with patients and tailoring screening to individual patients' needs. Methods: We developed a 90-minute session for second-year medical students as part of a gastroenterology and nutrition course. We provided a short lecture on colon cancer screening. We then had a panel of practicing gastroenterologists and a primary care physician discuss their approaches to six hypothetical cases. The students reflected in writing on what they learned from the session and on their opinions of the session format. Results: Of second-year medical students, 139 attended the session and 110 submitted written reflections on the session (79% response rate). The students perceived significant gains in knowledge, communication skills, and attitudes around the discussions. Discussion: This expert panel session taught medical students knowledge and communication skills related to colon cancer screening. The session could be easily implemented at any medical school, either at the preclinical or clinical level.

Genetic Testing and Counseling in Metabolic Liver Disease: An Interactive Lecture for Medical Students.

Introduction: Medical students have limited opportunities to learn about current genetic testing. This session provided exposure to different types of testing and the complex issues that physicians may encounter when counseling patients on proper testing and interpreting results. Methods: We designed a 1-hour interactive lecture for second-year medical students. We presented an overview of the topic, then applied the concepts to specific disorders and cases. Students were asked to answer questions regarding cases using an audience response system, and we used their responses as the basis for our in-class discussion. This session has been held twice, with 25 students attending in 2018 and 31 students in 2019. The session was also recorded so that additional students not in attendance could watch, and was available to 151 students in 2018 and 333 students in 2019. Results: Students answered questions via audience response system. There was a range of 47%-100% of students giving the correct answers in 2018, and 55%-93% in 2019. Exam questions covering genetic counseling issues were answered correctly by 66% and 77% of students in 2018, and 70% and 68% of students in 2019. Discussion: This session provided an opportunity for medical students to be exposed to some of the complex ethical and psychosocial issues that may arise with genetic testing for liver disease and to consider how to navigate them. Using an audience response system during the lecture made the session more interactive and allowed the teacher to correct errors and teach based on the responses.

Drug-Induced Liver Injury Module for Medical Students.

Introduction: No published curricula exist to introduce medical students to drug-induced liver injury (DILI). However, DILI is the most common cause of acute liver failure in the US, and drug-drug interactions are tested on the USMLE Step 1. Methods: We developed an independent study module to introduce students to DILI. This module consisted of a narrated PowerPoint introduction, a journal article, and four example cases. Students completed the module independently. To evaluate the effectiveness of the activity, exam data and responses to the cases were reviewed, and end-of-course survey data were used. These responses were used to modify questions for clarity and to develop a feedback rubric. Results: Mean scores on case-related questions in the module ranged from 44% to 73%. However, mean scores on test questions related to DILI ranged from 61% to 98%. It is possible that students learned from receiving feedback in the form of correct answers to the cases. On course evaluations, 52.4% of students agreed or strongly agreed that the online modules as a group (which included the DILI module) were an effective teaching method. Discussion: This module introduces students to DILI and enables them to interact with valuable resources. We hope that modifications will improve the learning experience and effectiveness of the module. Going forward, we plan to collect validity evidence for the feedback rubric and develop an advanced version of the module for gastroenterology fellows.

Does Increased Adenoma Detection Reduce the Risk of Colorectal Cancer, and How Good Do We Need to Be?

PURPOSE OF REVIEW: Colorectal cancer (CRC) is largely preventable with colonoscopy and other screening modalities. However, the effectiveness of screening and surveillance depends on the quality of the colonoscopy exam. Adenoma detection rate (ADR) is the best-validated metric by which we measure individual physicians' performance. RECENT FINDINGS: Recent evidence suggests that ADR benchmarks may be inappropriately low. There is proof that improving ADR leads to significant reductions in post-colonoscopy CRC (PCCRC). Two studies have demonstrated that when a colonoscopy is performed by physicians with higher ADRs, patients are less likely to have advanced adenomas on surveillance and less likely to develop or die from PCCRC. Finally, there is at least some evidence that higher ADRs do not lead to more cumulative surveillance exams. The ADR is a useful outcome measure that can provide individual endoscopists and their patients with information about the likelihood of developing PCCRC. To achieve the lowest possible PCCRC rate, we should be striving for higher ADRs. While strategies and innovations may help a bit in improving ADRs, our efforts should focus on ensuring a complete mucosal exam for each patient. Behavioral psychology theories may provide useful frameworks for studying motivating factors that drive a careful exam.

Bridging the gap for future clinician-educators.

BACKGROUND: In contrast to the training required in the UK, opportunities for medical education training in the USA are limited. Resident-as-teacher programmes are typically insufficient to prepare trainees to be successful clinician-educators, but few pursue formal education degrees. We sought to assess the need for, and feasibility of, a training pathway for subspecialty fellows in a large Department of Medicine that would prepare our trainees to become effective educators. METHODS: Quantitative and qualitative methods were used. Previous fellowship applicants and current programme directors were surveyed to determine the potential benefits of the programme. A pilot programme was conducted with fellows interested in education to determine the feasibility of the programme. Pilot participants were interviewed regarding the benefits that they gained from the pilot and the logistical challenges that they experienced. In contrast to the training required in the UK, opportunities for medical education training in the USA are limited RESULTS: Five highly ranked fellows would have scored our programmes higher if we offered this training pathway. Pilot participants and fellowship programme directors agreed that there is a compelling need for such a training pathway. A number of themes arose from the interviews that enabled us to build the framework for a strong programme. DISCUSSION: Our findings suggest that a clinician-educator training pathway that draws from multiple subspecialties has the potential to improve recruitment, provide needed career counselling and skills development to trainees, and to build a community of educators that will benefit the institution. Important insights from pilot participant interviews will inform the programme design, in order to keep trainees engaged and overcome logistical challenges.