Advancing Equity in Academic Medicine Through Holistic Review for Faculty Recruitment and Retention.

The Association of American Medical Colleges (AAMC) in 2007 developed the Holistic Review Framework for medical school admissions to increase mission-aligned student diversity. This approach balances an applicant's experiences, attributes, and metrics during the screening, interview, and selection processes. Faculty recruitment provides its own set of challenges, and there is persistent underrepresentation of certain racial and ethnic minority groups and women in faculty and leadership positions in U.S. academic health centers (AHCs). In 2019, the AAMC initiated a pilot program to adapt and implement the framework for use in faculty recruitment at AHCs. In this Invited Commentary, the authors describe the pilot implementation of the Holistic Review Framework for Faculty Recruitment and Retention and share lessons learned to date. Although the pilot proceeded during 2020, institutional implementation was impacted by the COVID-19 pandemic and racial justice movement. Pilot institutions encountered hiring freezes, reductions in funding, and restrictions on in-person meetings due to COVID-19 that resulted in both barriers and opportunities in implementing the framework. Renewed commitment to racial justice was associated with increased momentum and urgency for the implementation of faculty holistic review at the majority of pilot institutions. Common themes from the pilot leads' experiences included the importance of achieving "buy in," having a dedicated implementation team, and being explicit about core values. Other themes included the importance of adaptability and flexibility to meet the needs of different institutions and mission areas. The faculty holistic review framework has shown promise as an approach to advancing faculty diversity goals. The pilot institutions will continue to share best practices, track outcomes, implement quality improvement, and disseminate findings to assist other institutions and health care communities with their endeavors to recruit and retain diverse faculty.

Advancing Holistic Review for Faculty Recruitment and Advancement.

PROBLEM: The challenges to developing a physician and scientific workforce that both reflects and provides quality care for the complex and richly diverse population of the United States are considerable. APPROACH: One medical school (Baylor College of Medicine) sought to adapt the Holistic Review in Admissions process developed by the Association of American Medical Colleges and apply it to faculty. In the fall of 2016, academic leaders received on-site training and completed several workshop exercises. The goal was for the leaders to build consensus around a holistic review framework for hiring and advancing faculty that is based on the institution's mission, vision, and values. OUTCOMES: This training occurred during Baylor's ongoing strategic planning and helped inform improvements in the faculty recruitment and hiring process, in the guidelines for faculty appointment and promotion, and in the pilot of an administrative leadership candidate rating tool, the "experiences-attributes-academic metrics model." The model that developed from the pilot translates the holistic review concept into a tool for identifying, hiring, and promoting faculty members and administrative leaders that is aligned to the values of Baylor. The utility of this framework lies in the clear delineation of metrics and qualifications along with the prioritization of attributes and experiences. NEXT STEPS: This innovation is being piloted and evaluated to determine its effect on advancing the institutional mission of Baylor.

Student and resident perspectives on professionalism: beliefs, challenges, and suggested teaching strategies.

OBJECTIVE: The purpose of this study was to investigate the views of medical students and residents regarding the practice of professionalism, their perceived challenges, and ideas for the development of a new curriculum in medical professionalism. METHODS: Data were collected from four focus groups comprised of 27 residents and medical students recruited from the University of South Florida Morsani School of Medicine and Residency Programs between January and March 2012. A questioning protocol was used to guide the focus group discussion. Data were transcribed for thematic analysis. RESULTS: Learners expressed beliefs regarding key attributes of professional behaviors, factors perceived to be associated with lapses of professional behavior, skills that need to be taught, and strategies to teach professionalism from the learners' perspective. Learners perceived that the values of professionalism are often disconnected from the reality evidenced in clinical training due to a myriad of personal and contextual challenges. CONCLUSIONS: Residents and students need help in negotiating some of the challenges to medical professionalism that are encountered in clinical settings. We recommend a learner's centered model of curriculum development in medical professionalism that takes into consideration perceived challenges and strategies for modeling and reinforcing medical professionalism.

'The Loss of My Elderly Patient:' Interactive reflective writing to support medical students' rites of passage.

BACKGROUND: The fostering of reflective capacity within medical education helps develop critical thinking and clinical reasoning skills and enhances professionalism. Use of reflective narratives to augment reflective practice instruction is well documented. AIM: At Warren Alpert Medical School of Brown University (Alpert Med), a narrative medicine curriculum innovation of students' reflective writing (field notes) with individualized feedback from an interdisciplinary faculty team (in pre-clinical years) has been implemented in a Doctoring course to cultivate reflective capacity, empathy, and humanism. Interactive reflective writing (student writer/faculty feedback provider dyad), we propose, can additionally support students with rites of passage at critical educational junctures. METHOD: At Alpert Med, we have devised a tool to guide faculty in crafting quality feedback, i.e. the Brown Educational Guide to Analysis of Narrative (BEGAN) which includes identifying students' salient quotes, utilizing reflection-inviting questions and close reading, highlighting derived lessons/key concepts, extracting clinical patterns, and providing concrete recommendations as relevant. RESULTS: We provide an example of a student's narrative describing an emotionally powerful and meaningful event - the loss of his first patient - and faculty responses using BEGAN. CONCLUSION: The provision of quality feedback to students' reflective writing - supported by BEGAN - can facilitate the transformation of student to professional through reflection within medical education.

Begin the BEGAN (The Brown Educational Guide to the Analysis of Narrative) - a framework for enhancing educational impact of faculty feedback to students' reflective writing.

OBJECTIVE: The study aim was the development of a method to further enhance the educational benefit of medical students' reflective writing. The setting is a Doctoring course at the Warren Alpert Medical School of Brown University, which includes reflective writing assignments, termed "field notes", combining students' reflective writing with ongoing individualized feedback from small group faculty. METHODS: Three-year (2005-2008) iterative process with three stages of immersion, analysis, and revision that resulted in the analysis framework. An interdisciplinary team composed of the four authors with backgrounds in narrative medicine, qualitative research, psychology, and medical education analyzed 12 first and second year students' selected field notes in iterative cycles. In each cycle, consultations with small group faculty and content experts were conducted to further validate the emergent framework. RESULTS: This process culminated in the creation of the Brown Educational Guide to Analysis of Narrative (BEGAN) framework, a guide for crafting feedback to students' reflective writing, and the integration of the BEGAN framework into the faculty and student manuals for the Doctoring Course in 2008-2009. CONCLUSIONS: We propose the BEGAN framework as a useful innovative tool that can be incorporated in reflective writing curricula in the field of health professions education. It is tailored to support the educational impact of the course through additional scaffolding of student writing, and the robust process it delineates for crafting of faculty feedback. Providing systematic feedback to enhance reflective writing may represent the path forward in fostering professional development through reflection in health professions education. PRACTICE IMPLICATIONS: The BEGAN can be incorporated in reflective writing curricula in the field of health professions education. It is a springboard for the necessary next steps of development and research into the acquisition of reflective and narrative competence in the emerging professional.

Reflecting on reflections: enhancement of medical education curriculum with structured field notes and guided feedback.

The promotion of reflective capacity within the teaching of clinical skills and professionalism is posited as fostering the development of competent health practitioners. An innovative approach combines structured reflective writing by medical students and individualized faculty feedback to those students to augment instruction on reflective practice. A course for preclinical students at the Warren Alpert Medical School of Brown University, entitled "Doctoring," combined reflective writing assignments (field notes) with instruction in clinical skills and professionalism and early clinical exposure in a small-group format. Students generated multiple e-mail field notes in response to structured questions on course topics. Individualized feedback from a physician-behavioral scientist dyad supported the students' reflective process by fostering critical-thinking skills, highlighting appreciation of the affective domain, and providing concrete recommendations. The development and implementation of this innovation are presented, as is an analysis of the written evaluative comments of students taking the Doctoring course. Theoretical and clinical rationales for features of the innovation and supporting evidence of their effectiveness are presented. Qualitative analyses of students' evaluations yielded four themes of beneficial contributions to their learning experience: promoting deeper and more purposeful reflection, the value of (interdisciplinary) feedback, the enhancement of group process, and personal and professional development. Evaluation of the innovation was the fifth theme; some limitations are described, and suggestions for improvement are provided. Issues of the quality of the educational paradigm, generalizability, and sustainability are addressed.

Challenging linguistic barriers to health care: students as medical interpreters.

Inadequate medical interpretation services are a barrier to the delivery of optimal health care to persons with limited English proficiency. Even though Title VI of the Civil Rights Act of 1964 requires that interpretation services be available to persons speaking limited English, many health care institutions are struggling to reach full compliance. Communication through untrained interpreters is likely to include mistranslations or omissions of physicians' questions, truncated or slanted patient responses, and inadequate information to facilitate accurate diagnosis and treatment. The Interpreter's Aide Program (IAP) is a service-learning program that was implemented at Brown Medical School in 1997. The IAP is a collaborative effort among Brown students, the Rhode Island Hospital Department of Social Work, and Brown Medical School. This three-way partnership strengthens the IAP and expands interpretation services to Spanish- and Portuguese-speaking patients at Rhode Island Hospital. Bilingual undergraduate and medical students become trained medical interpreters and render community service while developing cross-cultural skills. The authors review the development and implementation of the IAP. There is potential for other academic health centers to develop similar partnerships with local colleges and universities, and to provide service-learning opportunities for future physicians and health care consumers.

Testing stage effects in an ethnically diverse sample.

The Transtheoretical Model (TTM) has been extensively validated in representative samples of adult smokers. Stage effects, i.e., the patterned relationships between Stage of Change (SOC) and other TTM variables, have been reported in a variety of samples. This study describes reliability data for the TTM variables and tests the stage effects with an ethnically diverse sample of 296 parents with young children. On the basis of theory and previous empirical evidence from a general population, it is possible to make quantitative predications about the magnitude of the expected effect sizes for the Decisional Balance, Situational Temptations, and Processes of Change subscales. For each variable, both a test of significance and a comparison with the expected effect sizes is reported. Results indicated significant stage differences for 8 of the 11 TTM subscales, and all quantitative predictions were confirmed. This study supports the use of TTM measures in an ethnically diverse sample.