Longitudinal outcomes one year following implicit bias training in medical students.

PURPOSE: Training in implicit bias is broadly recognized as important in medical education and is mandated by some accrediting bodies. This study examined medical students' retention of concepts immediately following and one-year post participation in an implicit bias workshop. METHODS: Study subjects were 272 third-year medical students who participated in workshops held between 2018-2020 that used the Implicit Associations Test (IAT) as a trigger for discussions in small groups. We developed a survey and administered it to students to capture their awareness of implicit bias pre-, post-, and one-year post-workshop attendance. Repeated Measures Analyses and independent-samples t-tests were used to examine for differences in responses on each of the seven survey items and a tabulated 7-item average of these seven items. RESULTS: Six of seven survey items and the tabulated 7-item average examined by Repeated Measures Analyses showed statistically significant increases between the pre-, post-, and one-year post-surveys (ps range: 0.01-0.07), with a small to moderate effect sizes (ƞp2s range: 0.01-0.07). Pairwise comparisons among these three surveys' results indicated statistically significant improvements between the pre- and the post-workshop surveys (ps range: 0.01-0.03) but no statistically significant differences between the post- and the one-year post-workshop surveys (ps range: 0.57-0.99). A separate sample of 17 off-cycle students who took the one-year post- workshop survey two years after the workshop did not differ statistically on the level of awareness of bias compared to those taking the same survey one year later, as examined by the two-group independent t-tests for the seven one-year post-workshop survey items (ps range: 0.56-0.99). CONCLUSIONS: The findings support one-year retention of knowledge and attitudes gained from an implicit bias workshop and suggest similar retention at two years. Future educational interventions that train learners to recognize and manage implicit and explicit behaviors in clinical practice are needed.

Violence against pregnant women and adverse maternal/ fetal outcomes in the United States: racial/ethnic disparities.

Violence against women is relatively common, and violence during pregnancy is of special concern due to potential risk of maternal and neonatal complications. Previous studies using diagnostic codes to determine prevalence and health outcomes of violence against women used ICD-9 data and lack a standard of consistency. Data from the 2002 to 2018 National Inpatient Sample (NIS) was used to analyze pregnancy-related hospitalizations of women aged 15-49 years. International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) was utilized in the NIS until the third quarter of 2015, after which it transitioned to ICD-10-CM format. The exposure was violence against women whereas outcomes included preterm birth, intrauterine fetal demise, miscarriage, fetal growth restriction, hypertensive disorders of pregnancy, and gestational diabetes. Temporal trends analyses were performed using Joinpoint regression technique and adjusted survey logistic regression models were conducted to examine the association between exposure and outcomes. Certain sociodemographic characteristics including age 35-49 (2.88/1,000 hospitalizations), non-Hispanic White (2.66/1,000) and non-Hispanic Black (2.61/1,000) racial/ethnic groups, and lowest quartile income (2.91/1,000) were associated with higher prevalence of violence. There was an overall increase in hospitalizations over the study period, the most significant being among non-Hispanic White patients (AAPC 18 percent, 95 percent CI = 10.3, 26.3). When compared to those with no exposure, individuals of all ethnic groups exposed to violence had increased risk of all adverse maternal/fetal outcomes. Higher prevalence of violence was associated with certain sociodemographic characteristics. Disparities in maternal/fetal adverse outcome risk were noted between ethnic groups. Additional studies are needed to ensure accuracy of violence data using diagnostic codes.

Utilizing Complexity Leadership Theory to Promote Faculty Mentorship and Resident Leadership.

OBJECTIVE: To create and evaluate a structured combined faculty mentorship/resident leadership program based on complexity leadership theory. DESIGN: In 2021, a logic model was used to create a 5 part bi-monthly resident leadership series utilizing administrative, adaptive, and enabling components of complexity leadership theory. Each of the 5 sessions had a nationally prominent senior faculty member mentor 3 junior faculty in creation of an interactive workshop that was delivered to resident physicians during scheduled didactics. Validated surveys were used to assess faculty post-mentorship experience and resident self-perception of leadership skills pre-and post-series. Descriptive statistics and 2-way ANOVA were performed; text comments underwent content analysis. SETTING: A large academic OB/GYN department at Baylor College of Medicine in Houston, Texas. PARTICIPANTS: Five faculty mentors, 15 junior faculty, and 48 residents participated in this program. All faculty mentors (5/5) and 87% (13/15) of mentees completed the post-mentorship survey. Resident response rate was 60% (29/48) pre-series and 63% (30/48) post-series. RESULTS: Both mentors and mentees rated the experience favorably (4.62 versus 5.29, p = 0.51). In open-ended comments, enabling components of mentorship process, such as approachability and expertise of the mentors, were most often noted as positive. Both mentees and mentors suggested administrative changes to the experience, such as longitudinal relationships between mentors and mentees. The mean score on the resident leadership questionnaire improved from 3.82 to 3.96 (5-point Likert scale, p = 0.30) with self-reported leadership skills improving in 8/9 domains, although none reaching statistical significance. Open-ended comments revealed that residents also most desired administrative changes in the leadership series, such as increased leadership opportunities and more interactive workshops. CONCLUSIONS: A structured combined faculty mentorship/resident leadership program formed utilizing complexity leadership theory was positively received. Participants most liked the enabling components of the series, with requested administrative changes in the future.

Enhancing the Teaching Environment: 3-Year Follow-Up of a Resident-Led Residents-as-Teachers Program.

BACKGROUND: Previous faculty-driven residents-as-teachers (RAT) models have had limited efficacy and sustainability. OBJECTIVE: To evaluate the acceptability and effects of a resident-led RAT program on resident teaching. METHODS: In October 2016, obstetrics and gynecology (OB/GYN) residents at a large academic institution implemented a resident-led RAT program, consisting of a steering committee of peer-selected residents with 2 faculty mentors who planned education-focused resident didactics and journal clubs, organized resident involvement in clerkship activities, and recognized residents who excelled in teaching as Distinguished Educators (DEs). From July 2016 through June 2019, using the Kirkpatrick Model, we evaluated the program with annual resident surveys assessing self-perception of 13 teaching skills (5-point Likert scale) and value of RAT program, institutional end-of-clerkship student evaluations of resident teaching, and resident participation in DE award. RESULTS: Annual resident survey response rates ranged from 63% to 88%. Residents' self-reported teaching skills improved significantly in 11 of 13 domains from 2016 to 2018 (improvements ranging from 0.87-1.42; 5-point Likert scale; P < .05). Of the 2018 respondents, 80% agreed that the resident-led RAT program added value to the residency. For 2017-2018 and 2018-2019 academic years, 47% and 48% of medical students (100% response rate) strongly agreed that residents provided effective teaching compared to 30% in 2016-2017 (P < .05). Ten residents have graduated as DEs during this time period. CONCLUSIONS: A resident-led RAT program increased residents' self-reported teaching skills, improved medical student perceptions of teaching quality, and was sustainable and acceptable over a 3-year period.

A Conceptual Model for Residents as Teachers in Obstetrics and Gynecology.

BACKGROUND: The learning environment in obstetrics and gynecology (OB/GYN) may have intrinsic differences that require modifying existing resident as teacher models for high-quality teaching. OBJECTIVE: To explore medical students' views of resident teaching on the OB/GYN clerkship in order to develop more effective educators. METHODS: Between October 2017 and June 2018, we performed medical student focus groups at the end of the 2-month OB/GYN clerkship. Topics discussed included positive and negative teaching interactions with residents, barriers specific to the OB/GYN clerkship, and best methods for resident teaching. Qualitative analysis utilizing 3 reviewers and N-Vivo software were used to identify themes. RESULTS: A total of 37 students participated in five focus groups. The most common barriers were a learning environment that was less predictable than on other rotations and lack of autonomy due to patient advocacy concerns. The three main contributors to positive learning experiences were team inclusion, clear expectations, and feedback. Negative interactions were passive learning experiences and inconsistent expectations. The best methods for resident teaching were verbalization of cognitive processes, preparation to use common patient encounters as teaching moments, and modeling skills needed for proficient patient care. DISCUSSION: The learning environment on OB/GYN is unpredictable and influenced by four Ps: patient autonomy, passive experiences, procedures, and preconceived notions. The strategy of a resident teacher should focus on medical student inclusion and preparation for teaching role. We thus suggest a TEAM (Thinking Aloud, Expectations, Advanced Preparation, Modeling) approach to improve resident teaching on the OB/GYN clerkship.

How to Teach Laboratory Stewardship in the Undergraduate Medical Curriculum?

OBJECTIVES: Promotion of high-quality care at a lower cost requires educational initiatives across the continuum of medical education. A needs assessment was performed to inform the design of an educational tool with the goal of teaching laboratory stewardship to medical students. METHODS: The needs assessment consisted of semistructured interviews with core clerkship directors and residency program directors at our institution, a national survey to the Undergraduate Medical Educators Section (UMEDS) of the Association of Pathology Chairs, and a review of existing online resources that teach high-value care. RESULTS: Two major themes emerged regarding opportunities to enhance laboratory stewardship education: appropriate ordering (knowledge of test indications, pretest/posttest probability, appropriateness criteria, recognition of unnecessary testing) and correct interpretation (understanding test specifications, factors that affect the test result, recognizing inaccurate results). CONCLUSIONS: The online educational tool will focus on the curricular needs identified, using a multidisciplinary approach for development and implementation.

Use of an Obstetric Balloon for Postabortion Hemorrhage With Disseminated Intravascular Coagulation.

BACKGROUND: Postabortion hemorrhage occurs in up to 2% of second-trimester pregnancy terminations. Postabortion hemorrhage is the leading cause of postabortion maternal mortality. We report the successful use of an obstetric balloon for second-trimester postabortion hemorrhage complicated by disseminated intravascular coagulation. CASE: A 38-year-old multigravid woman presented with hypovolemic shock from disseminated intravascular coagulation after second-trimester termination of an anomalous fetus. An intrauterine Foley catheter filled with 60 mL of fluid failed to tamponade bleeding. An obstetric balloon filled with 330 mL of fluid temporized bleeding until the patient's coagulopathy was corrected. CONCLUSION: An obstetric balloon should be considered in the management of second-trimester postabortion hemorrhage complicated by disseminated intravascular coagulation while coagulopathy is corrected.