Diversity, Equity, & Inclusion in Health Professions Education
Abstracts are in the order they will be presented for both Lightning Talk blocks on Monday, December 5
Roseman University of Health Sciences College of Medicine
The LCME requires medical schools to address health disparities, cultural differences, and service learning for medical students. These competencies are increasingly being taught under frameworks such as Social Determinants of Health (SDoH) or structural competency. Medical educators have collaborated with public health, social sciences, and behavioral sciences. Despite this important step, health disparities remain and distrust in the medical profession and healthcare systems grows. We propose that integrating the humanities and those trained in humanistic disciplines into UME will do more to help address structural inequity and racism in medicine. Traditionally, humanities have been integrated into medical education curricula to improve communication, cultivate empathy, prevent burnout, tolerate ambiguity, and improve observational skills. But educators trained in the humanities can also teach learners to describe structural factors that affect health and healthcare, identify health disparities and inequities from a narrative perspective, situate medicine within a social-ecological model of individual and public health, identify and address upstream factors that affect individual patients in the context of their lived experience, and participate in policy change. Humanities concentrates on the first person, lived experience of human beings and conceptual, critical, and creative thinking. Narrative brings abstract concepts like health equity to life by giving them concrete form and engages our thinking and emotions which fosters retention. Successful examples from health humanists working in three different medical schools across the US will be offered.
Gillis, M., Lemus‐Martinez, S., & DeBaets, A. M. (2020). Toward a scholarship of teaching and learning: addressing ethics and humanities in health professions education. New Directions for Teaching and Learning, 2020(162), 157-166. https://doi.org/10.1002/tl.20400
College of Medicine, University of Houston
Racism and other forms of discrimination against minoritized populations are increasingly recognized as a public health crisis requiring attention and innovative solutions across disciplines, including medical education. To provide compassionate and high-value healthcare, providers and medical students must recognize physiological and clinical manifestations of stress in response to social discrimination and have the tools to communicate with their patients in a culturally responsive manner. Here, we describe the co-creation, implementation, and evaluation of a learning session from a pre-clerkship nervous system course about the effects of discrimination on the body's stress response. Second-year medical students (M2) and neuroscience faculty developed an hour-long flipped classroom teaching session addressing discrimination-related manifestations of stress. To prepare for the session, first-year medical students (M1) were assigned academic texts and lecture videos to review. Before class, M1 teams created clinical case examples of patients experiencing stress related to racism, heterosexism, and ableism. During class, students used the cases to facilitate group discussions on how providers can utilize screening tools and patient-physician dialogue frameworks to improve patient quality of care. M1 students identified the manifestations and physiologic mediators of acute and chronic stress on various body systems. After the session, a debriefing period was offered to address lasting concerns and offer additional resources to M1 student learners. A questionnaire was distributed to M1 students after the session to elicit quantitative and qualitative responses. 87% (Mean = 8.3, STDEV = 1.7 (0-10 scale)) of students agreed with the statement that the session increased their overall understanding of the role of discrimination in the development of stress-related illnesses. 100% of students agreed with the statement that the session dealt with sensitive issues in a culturally responsive manner. Qualitative student responses indicated that the participation of M2 students was valued, and that the session delivery was perceived as authentic and delivered in a respectful manner. This peer-created, peer-delivered teaching session incorporated M2 students to create prework material, provide didactic instruction, facilitate small group discussion, and lead a debrief session, and was exceptionally well-received by M1 students. Peer-led course delivery and interactive clinical case creation facilitated reflective conversations amongst students and faculty in a supportive environment. Co-curriculum design with faculty and diverse student leaders offers a unique opportunity to incorporate different perspectives and create active learning opportunities for students to address discrimination and other challenging DEI topics that require authenticity and respect.
University of Michigan Medical School
"Med Twitter" is a subculture on the social media platform Twitter characterized by medical students, interns, residents and attending physicians who "tweet" 280 character length comments on medically related topics. For medical students, "Med Twitter" is often notably used for student self-promotion to boost competitiveness for residency applications. Students leverage the platform to share accomplishments such as publications, awards, and scholarships, as well as particularly remarkable patient experiences that highlight their skills. Given that US medical students are predominantly white, upper middle class, and more likely than the general population to have parents who are doctors (Weiss et al., 2021), it is no surprise that "Med Twitter" primarily showcases the experiences of medical students with these dominant identities. Furthermore, one could view "Med Twitter" as a part of the "Hidden Curriculum" of medical education, which is often not transparent and thus out of reach of minority and disadvantaged students (Brown et al., 2020). Thus, it is imperative to create alternative spaces that are more diverse, equitable and inclusive. Our project, bemused, aims to create an alternative space for students that is inclusive of all students and their experiences. Bemused will be a student-run collection of surprising, confusing, and a bit amusing moments that brought medical students laughter and reflection during their early exposures to the clinical space. Stories of silly mistakes and hilarious blunders that call attention to an essential (and universal) component of the medical student experience, failure, will be welcomed. Bemused will feature stories from medical students, interns, residents and faculty on their early clinical experiences to remind students that every member of the care team were once making embarrassing mistakes. The stories from Bemused will first be shared live at a public launch party with writers reading their pieces, fostering communal reflection and laughter. During and following the launch, hard copies of Bemused will be distributed. Thus, bemused is a wellness initiative that deconstructs the culture of maladaptive perfectionism perpetuated on "Med Twitter" (Brennan-Wydra et al, 2021) which aims to promote DEI by creating an alternative, transparent space that celebrates stories from diverse students. Unlike "Med Twitter," bemused will be marketed to all students, with clear information about the possible benefit of participating (i.e. promoting wellness and a possible citation for their ERAS application).
The Lightening Talk will focus on sharing the following:
1) the purpose of bemused
2) the development of bemused as a novel approach to medical student wellness
3) the progression of bemused
4) bemused's effectiveness in deconstructing maladaptive perfectionism and promoting DEI at a US Midwestern medical school
5) reflections from medical student leadership.
Purpose Diversifying the higher education begins with two factors necessary for successful applicant recruitment, student matriculation and retention, and ultimately successful program completion: accessibility and inclusivity. Graduate student training often spans a student's reproductive years. However, most programs do not have inclusive or accessible parental leave policies for students and applicants.1 The absence of policies and the discriminatory nature of existing policies affect all students wishing to become parents but disproportionately limits academic and career growth for women.1 Policies should be inclusive to gender identity, sexual orientation, and nontraditional families, including adoption and surrogacy. This project brings together educators in the fields of admissions, wellness, and inclusion to examine the creation and dissemination of inclusive parental leave policies, focusing on policy with a disproportionate effect on women who are underrepresented in many graduate fields.1 Engagement The session will begin with a brief presentation highlighting trends admissions and research on inclusive parental leave policies. Next, attendees will participate in an interactive exercise reviewing examples of blinded program policies, identifying problematic areas, and generating inclusive revisions. Finally, facilitators will lead a discussion on navigating institutional barriers that can make policy change difficult, leaving time for participants to share their policy change experiences. Evidence Students are more likely to engage in learning when they feel recognized.2 As graduate programs begin to focus on holistic admissions, programs must consider the effects policies have on creating cultures of inclusivity; this includes efforts to reduce sex-based discrimination in education and training.3 Original research from the presenters has found that 13% (38/282) of PA programs mention parental leave on their websites or handbooks available to applicants, and 60.5% of these 38 policies discriminate based on sex. Similar data has been found among medical training programs.3 Faculty are in a unique position to promote wellness and inclusivity through deliberate and thoughtful policy changes.
1. Ajayi KV, Ma P, Akinlotan M. Commentary: COVID-19 and the vulnerability of single mothers in institutions of higher education. Fam Community Health. 2021;44(4):235-237
2. Ambrose, S. A., Bridges, M.W., DiPietro, M. & Lovett, M.C. (2010). How learning works: Seven research-based principles for smart teaching. San Francisco, CA: Jossey Bass.
3. Kraus MB, Talbott JMV, Melikian R, Merrill SA, Stonnington CM, Hayes SN, Files JA, Kouloumberis PE. Current Parental Leave Policies for Medical Students at U.S. Medical Schools: A Comparative Study. Acad Med. 2021;96:1315-1318. doi:10.1097/ACAM.0000000000004074.
Kiran C. Patel College of Allopathic Medicine
As many new medical schools emerge and curricular reforms are underway as a national trend, the focus on active learning and early clinical immersion in program deliverables is becoming more appropriate to prepare students for diverse patient populations and interprofessional collaborations as health care professionals. Pre-clinical education programs are predominately comprised of basic science educators (PhD, EdD) who participate in facilitating active learning activities. Directed clinician involvement can have a cascade effect for improving the training programs for non-clinical faculty. Active learning activities like Problem-Based Learning (PBL), Team-Based Learning (TBL), and Case-Based Learning (CBL) that focus on a patient presenting with a problem and psychosocial considerations can be used to reinforce a multitude of essential skills for the clinical setting, such as critical thinking, clinical reasoning, and compassionate care. Through carefully designed programming, minimal effort of clinicians is needed to successfully train and support non-clinical faculty. A targeted faculty development approach can be used to train faculty to strengthen students in translating active learning activities to the clinical setting. During this lightening talk, we will share ways to incorporate clinical faculty into the development of curricular materials and the training of non-clinical faculty. We will present examples of the various active learning activities and the support system we use in our program that takes advantage of clinical integration, student reflection on psychosocial topics and a patient-centered approach. The training is modular such that it can be adapted to interprofessional education and the virtual environment. As presenters of this lightening talk, we will present a 7-minute introduction to this topic and be prepared to facilitate a discussion with probing questions if necessary.
The purpose of this session is to explore evidence-based demographic considerations for creating and delivering wellness curricula. Evidence: Mental illness and decreased well-being are recognized as pervasive concerns throughout medical training and accreditation standards across multiple disciplines now require wellness curriculum.1-3 However, there is little evidence that identifies the best approach to wellness curricular integration in medical education.4 This discussion is supported by the authors' original research where first year physician assistant (PA) students from 5 programs (n=259) participated in a 16-week asynchronous virtual course. The course integrated evidence-based content on vulnerability and stigma, mindfulness and decentering, and reflective writing. Total weekly content averaged 30-60 minutes and was presented in multiple formats. Students completed anonymous pre- and post-surveys and OLS regression with a fixed effect for each school was used for data analysis. In total, 157 of 259 (60.6%) students completed both surveys with matching unique identifiers. The majority of students (73.6%; 134/182) endorsed the course having a positive impact on their training as a PA student. Baseline scores were significantly predictive of end-point scores for the Philadelphia Mindfulness Scale (PHLMS), Opening Minds Stigma Scale for Health Care Providers (OMS-HC-15), Self-Stigma of Seeking Help (SSOSH), Reflective Practice Questionnaire (RPQ), and UCLA 3-item Loneliness Scale (UCLA-3). Race was significantly predictive of PHLMS and OMS-HC-15 scores, age was significantly predictive of SSOSH scores, and gender was significantly predictive of RPQ scores. For example, individuals not identifying as white had OMS-HC-15 scores a predicted 2.59 points higher than those that identify as white (higher scores equate to higher levels of stigmatization; possible range 15-75). Participants who do not identify as white had a higher baseline level of stigma than those who identify as white. Additionally, a decline in stigma over the course of the program for this group was not experienced. Additionally, for those who do not identify as white and had a pre-program score of 34 or higher, a change in stigma was also not experienced. For individuals who identify as white, there was a significant decrease in stigma at the completion of the program, unlike participants who do not identify as white. Engagement: For a student with low baseline well-being who is entering a PA program, dedicated curricula focusing on foundational wellness skills can be successful in improving well-being. However, consideration must be made to the applicability of content to students of varied racial and ethnic backgrounds, as well as age of the learner. As medical education continues to move towards more diverse student populations, attention must be paid to the nature of the curriculum being developed and its efficacy in supporting diverse student populations.
Mercer University School of Medicine
In response to the global pandemic early in 2020, the landscape of academic medicine shifted dramatically. Certainly, the difficulties and stressors experienced by the clinical workforce were apparent. Published articles projected scientific setbacks that would last for decades. And, for education, scholarly works described the effects that moving to a virtual (remote) format had on student learning, highlighting both inequities as well as innovations that resulted from the new online platform. However, very few (if any) studies to date have described the unique impact that virtual learning and "work-from-home" orders had on medical educator faculty. To address this gap, our research team issued a survey to medical educators (through local networks and the IAMSE membership; n=195 responses). Accordingly, our COVID Equity Survey prompted data collection for comparing "PRIOR TO" and "DURING COVID" experiences of faculty across a range of professional roles and domestic contexts. Our working hypotheses, generally speaking, were that COVID-related "work-from-home" situations could have been affecting vulnerable groups disproportionately. Although the study is ongoing (as analysis for qualitative data and a Delphi probe continue), the survey alone yielded numerous significant findings, including disparities across gender and faculty rank. Our analyses show "work-from-home" orders indeed affected medical educators across all explanatory classifications. Yet, results gender — response contingencies indicated a "COVID effect" that was significantly more pronounced for female educators. Greater rates of women felt overwhelmed by personal and professional responsibilities. They did not feel they were making effective use of their time. Perhaps most alarming was our finding that only 30% of the women in our study were satisfied with work-home balance during the pandemic. Other significant findings revealed impact in career advancement. While 72% of female educators agreed or strongly agreed that they were producing quality work during "work-from-home" orders, only 46% felt that they were on track to achieve their career goals. This may be due to balancing home responsibilities, as faculty rank — response contingencies revealed significant differences, with assistant professors reporting that they were solely responsible for more domestic obligations than associate professors. Importantly, this project represents a multi-institutional effort, including a team of 7 medical student researchers, who provided fresh insights during our analysis - essentially allowing us to capture "lightning in a bottle." In a lightning session, a co-PI will present select data that showcases the unique experiences of junior faculty and women during "work-from-home" COVID mandates. In addition, we will feature student reflections on gender equity and mixed-methods research, highlighting the impact of participating in this collaborative project.
Georgetown University School of Medicine
Diversity in medical education is imperative for future physicians as they prepare to treat heterogeneous populations throughout their careers. However, studies show that underrepresented minority (URM) or first-generation pre-medical students are more likely to encounter factors shown to negatively affect academic achievement and less likely to be exposed to positive factors throughout the medical school application process. Currently, in-depth support and guidance for the application process, including application review, secondary essay editing, and interview preparation, is available only for those willing and able to pay for costly, third party "admission consulting" agencies. The inaccessibility of these services disproportionately impacts URM and first-generation students. To address this need, Georgetown University (GU) School of Medicine students developed an extension of the previously established mentorship program, Students Helping Aspiring Physicians Excel (SHAPE), emphasizing support for URM and first-generation students. The SHAPE program leverages GU's Office of Diversity, Equity, and Inclusion (ODEI)'s unique position to connect undergraduate and graduate students. The new initiative, called the SHAPE Summer Mentors Program, provides additional structure to the existing SHAPE program for those actively applying to medical school and strengthens "in-house" mentorship by pairing GU medical student mentors with GU premedical student mentees for ongoing advice and guidance at no additional cost.
The SHAPE initiative is comprised of the following components:
1) The general SHAPE program involves mentorship of underrepresented groups prior to medical school where medical student mentors and undergraduate mentees meet monthly to discuss pre-medical school advice in addition to attending paneled events regarding professional development. The program strives to encourage mentees to pursue a career in medicine, instruct on best practices for admission to medical school, and create meaningful and sustainable relationships between pairs.
2) Summer Mentors Program focused on applying to medical school - 7-week mentorship experience provides individualized support from a first-year medical student (M1) mentor carefully matched to the mentee, based on mentee preferences. The M1 Mentors are trained by a medical student leadership team (SHAPE Leaders) to use a series of thought exercises and interactive PowerPoints to help mentees address difficult secondary essay themes and articulate their personal motivations to pursue medical school. M1 mentors are required to spend two hours per week via Zoom with their mentees working through the SHAPE Summer Mentors curriculum.
3) Oversight of the M1 mentors participating in the Summer Mentors program provided by SHAPE Leaders who serve as points of contact for program participants and track M1 mentors' performance to ensure delivery of equitable and high-quality mentorship to mentees.
Case Western Reserve University
The use of race as a biological construct without proper social, political, and historical context is dangerous and can lead to the perpetuation of racism and racial and ethnic health disparities.1-4 The goal of this project was to assess the ways in which race and ethnicity are presented in the Foundations of Medicine and Health pre-clerkship curriculum at Case Western Reserve University School of Medicine and appreciate ways in which the curriculum could improve to be more structurally competent. This project began by creating ten learning objectives to guide instructors and students on the skills and knowledge necessary to promote race and ethnic diversity in medicine. We systematically reviewed 398 lectures with 20,630 slides across six basic science integrated blocks from 2020-2022 looking for the following terms: race, ethnicity, black, white, asian, hispanic, native American, racial, or photos of people of color. Each lecture PowerPoint was reviewed for the relevant terms and images; and the following information was recorded for each reference: faculty author, block, lecture title, number of slides in that lecture that mentioned key terms, topic covered in the lecture that included race-ethnicity, application of the term (e.g risk, diagnostic), and areas for improvement. The results of this project were the creation of 10 learning objectives that are consistent with Cultural Competence Education for Medical Students guidelines AAMC standards. Curricular examination identified 245 slides across ninety lectures in the 2020-2022 preclinical curriculum that mention race, ethnicity, black, white, Asian, Hispanic, Native American, racial, or contain photos of racially and ethnically diverse people. Of the 245 slides reviewed, 220 slides (89%) mentioned key terms as biological constructs without proper mention of structural factors. The results of this project are in alignment with previous literature on the subject.17 Added context should be included throughout all the preclinical curriculum to ensure that students are prepared to effectively care for individuals from a variety of races and ethnic backgrounds. Moreover, medical education still lacks a concise and direct way to discuss race and ethnicity. The learning objectives created in this project offer a framework on how to make discussion on race and ethnicity in medicine relevant, accurate, and solution oriented.