A decade of faculty development for health professions educators: lessons learned from the Macy Faculty Scholars Program.

Faculty development (FD) programs are critical for providing the knowledge and skills necessary to drive positive change in health professions education, but they take many forms to attain the program goals. The Macy Faculty Scholars Program (MFSP), created by the Josiah Macy Jr. Foundation (JMJF) in 2010, intends to develop participants as leaders, scholars, teachers, and mentors. After a decade of implementation, an external review committee conducted a program evaluation to determine how well the program met its intended goals and defined options for ongoing improvement.The committee selected Stufflebeam's CIPP (context, input, process, products) framework to guide the program evaluation. Context and input components were derived from the MFSP description and demographic data, respectively. Process and product components were obtained through a mixed-methods approach, utilizing both quantitative and qualitative data obtained from participant survey responses, and curriculum vitae (CV).The evaluation found participants responded favorably to the program and demonstrated an overall increase in academic productivity, most pronounced during the two years of the program. Mentorship, community of practice, and protected time were cited as major strengths. Areas for improvement included: enhancing the diversity of program participants, program leaders and mentors across multiple sociodemographic domains; leveraging technology to strengthen the MFSP community of practice; and improving flexibility of the program.The program evaluation results provide evidence supporting ongoing investment in faculty educators and summarizes key strengths and areas for improvement to inform future FD efforts for both the MFSP and other FD programs.

Medical School Rankings-Bad for the Health of the Profession and the Public.

This Viewpoint discusses the limitations of medical school ranking in attracting a diverse student population and urges administrators to holistically communicate their mission, goals, and learning environment as an alternative strategy.

Assessing competencies during education in psychiatry.

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.

Prioritizing Asian Americans, Native Hawaiians, and Pacific Islanders in the U.S. Health Equity Agenda.

Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations are growing rapidly in the United States, yet AANHPIs remain understudied, overlooked, and misunderstood. During the COVID-19 pandemic, themes from the tragic history of anti-Asian bias and marginalization have resurfaced in a surge of renewed bigotry and xenophobic violence against AANHPIs. In this commentary, the authors discuss the role of medical schools in combating anti-Asian sentiment as an important step toward achieving health equity. Based on their collective expertise in health disparities research, medical education, and policy, they offer suggestions about how to disrupt the pattern of invisibility and exclusion faced by AANHPI populations. They consider ways that representative data, leadership in medical education, research funding, national policies, and broad partnerships can help address AANHPI health disparities.

Resources for medical education: finding the right prescription.

What are the resources necessary to provide the highest quality education for medical students? This is the essential question which must be answered before a medical school can make a rational decision about the number of students to have in each class. In deciphering an objective way to determine the class size of a medical school, this paper explores the principles of medical education, accrediting organizations institutional expectations in providing a medical education program, and the author's personal experiences. The central tenets of a quality medical education include: learning by doing, student-centered learning, and the transmission of the attitudes, values and behaviors of the medical profession. This paper considers how these core components of medical education can be achieved and what resources are necessary to ensure that all students are appropriately supported.

Alpha Omega Alpha in the 21st Century: One School's Approach.

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.

Building Equity, Inclusion, and Diversity Into the Fabric of a New Medical School: Early Experiences of the Kaiser Permanente Bernard J. Tyson School of Medicine.

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.

Supporting Inclusive Learning Environments and Professional Development in Medical Education Through an Identity and Inclusion Initiative.

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.

Improving inpatients' identification of their doctors: use of FACE cards.

BACKGROUND: Improving patients' ability to identify their inpatient physicians and understand their roles is vital to safe patient care. Picture cards were designed to facilitate physician introductions. The effect of Feedback Care and Evaluation (FACE) cards on patients' ability to correctly identify their inpatient physicians and on patients understanding of physicians roles was assessed. METHODS: In October 2006, team members introduced themselves with FACE cards, which included a photo and an explanation of their roles. During an inpatient interview, research assistants asked patients to name their inpatient physicians and trainees and to rate their understanding of their physicians' roles. RESULTS: Of 2,100 eligible patients, 1,686 (80%) patients participated in the baseline period, and 857 (67%) of the 1,278 patients in the intervention period participated in the evaluation. With the FACE intervention, patients were significantly more likely to correctly identify at least one inpatient physician (attending, resident, or intern; baseline 12.5% versus intervention 21.1%; p < .001). Of the 181 patients who were able to correctly identify at least one inpatient physician in the intervention period, research assistants noted that 59% (107) had FACE cards visible in their rooms. Surprisingly, fewer patients rated their understanding of their physicians' roles as excellent or very good in the intervention period (45.6%) compared with the baseline period (55.3%; p < .001). DISCUSSION: Although FACE cards improved patients ability to identify their inpatient physicians, many patients still could not identify their inpatient doctors. FACE cards may have served as a reminder to physicians to introduce themselves to their patients. The FACE cards also served to highlight patients' misunderstanding of their physicians' roles.

Improving sleep hygiene of medical interns: can the sleep, alertness, and fatigue education in residency program help?

BACKGROUND: Because of concerns regarding sleep deprivation, the Accreditation Council for Graduate Medical Education limits duty hours and endorses education regarding sleep loss for residents. We assessed the effectiveness of a 60- to 90-minute lecture, the Sleep, Alertness, and Fatigue Education in Residency (SAFER) program, on sleep loss and recovery sleep in residents adhering to Accreditation Council for Graduate Medical Education duty hours. METHODS: From July 1, 2003, through June 24, 2005, interns from the inpatient medicine service at the University of Chicago were asked to wear wristwatch activity monitors. In March 2005, interns received the SAFER program intervention. We used fixed-effects linear regression to estimate within-subject mean sleep per call day (on-call, precall, postcall, and second-day postcall sleep). These estimates were compared with recommended minimum levels of preventive (7 hours of precall) and recovery (16 hours during the 2 days after call) sleep in healthy populations using 2-tailed t tests. These analyses were repeated to test the effect of the SAFER program. RESULTS: Fifty-eight of 81 interns (72%) participated for 147 intern-months (63%). Interns on call slept an average of 2.84 hours (95% confidence interval, 2.75-2.93 hours). Interns obtained less than recommended amounts of recovery sleep (14.06 hours [95% confidence interval, 13.84-14.28 hours]; P < .001). Intern preventive sleep was also less than recommended (6.47 hours [95% confidence interval, 6.39-6.56 hours]; P < .001). Interns attempted to compensate for their acute sleep loss; for each hour of on-call sleep loss, they received 18 minutes (95% confidence interval, 7-30 minutes) more recovery sleep (P = .003). The SAFER program had no significant beneficial effect on intern sleep. CONCLUSIONS: Under the current duty-hour regulations of the Accreditation Council for Graduate Medical Education, residents continue to be sleep deprived. The SAFER program has no impact on resident precall or postcall sleep.

Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities.

CONTEXT: Further restrictions in resident duty hours are being considered, and it is important to understand the association between workload, sleep loss, shift duration, and the educational time of on-call medical interns. OBJECTIVE: To assess whether increased on-call intern workload, as measured by the number of new admissions on-call and the number of previously admitted patients remaining on the service, was associated with reductions in on-call sleep, increased total shift duration, and lower likelihood of participation in educational activities. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of medical interns at a single US academic medical center from July 1, 2003, through June 24, 2005. Of the 81 interns, 56 participated (69%), for a total of 165 general medicine inpatient months resulting in 1100 call nights. MAIN OUTCOME MEASURES: On-call sleep duration, estimated by wrist watch actigraphy; total shift duration, measured from paging logs; and participation in educational activities (didactic lectures or bedside teaching), measured by experience sampling method via a personal digital assistant. RESULTS: Mean (SD) sleep duration on-call was 2.8 (1.5) hours and mean (SD) shift duration was 29.9 (1.7) hours. Interns reported spending 11% of their time in educational activities. Early in the academic year (July to October), each new on-call admission was associated with less sleep (-10.5 minutes [95% confidence interval {CI}, -16.8 to -4.2 minutes]; P < .001) and a longer shift duration (13.2 minutes [95% CI, 3.2-23.3 minutes]; P = .01). A higher number of previously admitted patients remaining on the service was associated with a lower odds of participation in educational activities (odds ratio, 0.82 [95% CI, 0.70-0.96]; P = .01]. Call nights during the week and early in the academic year were associated with the most sleep loss and longest shift durations. CONCLUSION: In this study population, increased on-call workload was associated with more sleep loss, longer shift duration, and a lower likelihood of participation in educational activities.

Promoting an environment of professionalism: the University of Chicago "Roadmap".

In 2005, the University of Chicago Pritzker School of Medicine unveiled an institution-wide Roadmap to Professionalism designed to both increase awareness about issues of medical professionalism across the institution and gain a better understanding of how medical trainees' professional behaviors' change during their training as a result of the medical learning environment. The authors describe the institution's approach and progress to date. To gain buy-in from all levels of learners at the Pritzker School of Medicine, the initiative uses vertically integrated advisory groups to engage medical trainees in the assessment and development of experiential workshops and evaluation initiatives based on the principles outlined in the American Board of Internal Medicine / American College of Physicians / European Federation of Internal Medicine's Physician Charter for Medical Professionalism. Advisory groups provide targeted assessments and programming at each stage of the medical learner: preclinical students, clinical students, residents, and faculty. Surveys of medical students' perceptions of professionalism have provided an important baseline assessment of the learning environment, from which the professionalism steering committee plans to target future curricular interventions. Efforts to engage residents have focused on experiential workshops addressing interactions with the pharmaceutical industry and patient-care hand-offs, as well as the development of a tool for patients to evaluate their resident physicians. The establishment of a series of medical education grants aimed at supporting professionalism research has helped raise faculty awareness. This institution's approach and experience to date may provide valuable lessons for educators and leaders aiming to assess and improve their learning environments.

Third-year medical students' participation in and perceptions of unprofessional behaviors.

BACKGROUND: Students' perceptions of and participation in unprofessional behaviors may change during clinical clerkships. METHOD: Third-year students anonymously reported observation, participation, and perceptions of 27 unprofessional behaviors before and five months after clerkships. RESULTS: Student observation (21 of 27) and participation (17 of 27) in unprofessional behaviors increased (P < .05). Students perceived unprofessional behaviors as increasingly appropriate (P < .05 for six behaviors). Participation in unprofessional behaviors was associated with diminished likelihood of perceiving a behavior as unprofessional (P < .05 for nine behaviors). CONCLUSIONS: Student observation and participation in unprofessional behaviors increased during clerkships. Participation in unprofessional behaviors is associated with perceiving these behaviors as acceptable.