ABSTRACT

Background

Academic medicine needs more diverse leadership from racial/ethnic minorities, women, people with disabilities, and LGBTQIA+ physicians. Longitudinal structural support programs that bring together underrepresented in medicine (UiM) and non-UiM trainees are one approach to build leadership and scholarship capacity in diversity, equity, and inclusion (DEI).

Objective

To describe the creation, satisfaction with, and feasibility of a Leadership Education in Advancing Diversity (LEAD) Program and evaluate scholars' changes in self-efficacy, intended and actual behavior change, and outputs in leadership and DEI scholarship.

Methods

In 2017, we created the LEAD Program, a 10-month longitudinal, single institution program that provides residents and fellows (“scholars”) across graduate medical education (GME) with leadership training and mentorship in creating DEI-focused scholarship. In the first 3 cohorts (2017–2020), we assessed scholars' self-efficacy, actual and planned behavior change, and program satisfaction using IRB-approved, de-identified retrospective pre-/post-surveys. We measured scholarship as the number of workshops presented and publications developed by the LEAD scholars. We used descriptive statistics and paired 2-tailed t tests to analyze the data.

Results

Seventy-five trainees completed LEAD; 99% (74 of 75) completed the retrospective pre-/post-surveys. There was statistically significant improvement in scholars' self-efficacy for all learning objectives. All trainees thought LEAD should continue. LEAD scholars have created workshops and presented at local, regional, and national conferences, as well published their findings. Scholars identified the greatest benefits as mentorship, developing friendships with UiM and ally peers outside of their subspecialty, and confidence in public speaking.

Conclusions

LEAD is an innovative, feasible GME-wide model to improve resident and fellow self-efficacy and behaviors in DEI scholarship and leadership.

ABSTRACT

Background

Holistic review promotes diversity, but widespread implementation remains limited.

Objective

We aimed to develop a practical approach to incorporate holistic review principles in screening applicants in the Electronic Residency Application Service (ERAS) and to assess the impact on diversity.

Methods

Three residency programs (internal medicine [IM], pediatrics, and surgery) at McGovern Medical School developed filters to identify applicants with experiences/attributes aligned with the institutional mission. These filters were retroactively applied to each program's 2019–2020 applicant pool using built-in ERAS capabilities to group applicants by user-defined features. We compared the demographics of applicants reviewed during the cycle with those identified retrospectively through experiences/attributes filters.

Results

The IM, pediatrics, and surgery programs received 3527, 1341, and 1313 applications, respectively, in 2019–2020. Retrospective use of experiences/attributes filters, without scores, narrowed the IM applicant pool for review to 1301 compared to 1323 applicants reviewed during actual recruitment, while the pediatrics filters identified 514 applicants compared to 384 at baseline. The surgery filters resulted in 582 applicants, but data were missing for baseline comparison. Compared to the baseline screening approach utilizing scores, mission-based filters increased the proportions of underrepresented in medicine applicants selected for review in IM (54.8% [95% CI 52.1–57.5] vs 22.7% [20.4–24.9], P < .0001) and pediatrics (63.2% [95% CI 59.1–67.4] vs 25.3% [20.9–29.6], P < .0001).

Conclusions

Program directors can leverage existing ERAS features to conduct application screening in alignment with holistic review principles. Widespread implementation could have important repercussions for enhancing physician workforce diversity.

ABSTRACT

Background

Transformative learning (TL) is an educational theory focused on deep fundamental shifts in an individual's worldview. Such shifts are well known to occur within graduate medical education (GME). However, TL in GME has yet to be formally explored.

Objective

We performed a scoping review of the literature on TL within GME to identify areas where trainees currently experience or have potential to experience TL, and to explore areas where fostering TL has been used as a pedagogical tool.

Methods

In January 2020, we searched 7 databases to identify literature on TL in GME. Additional articles were identified by hand-searching the Journal of Graduate Medical Education.

Results

A total of 956 articles were identified through database search with 3 unique articles found via hand-searching. Abstracts and manuscripts were screened by 2 authors and disagreements arbitrated by a third, yielding 28 articles for our analysis. The main components of TL (disorienting dilemma, reflection, discourse, action) took various forms. TL was closely linked with professionalism training and professional identity formation. Training programs in primary care fields were most frequently referenced. Often, trainees were experiencing TL without recognition of the theory by their educators. Gaps in the graduate medical education literature exist pertaining to TL in venues such as diversity, equity, and inclusion.

Conclusions

Our scoping review uncovered the following themes: TL and professionalism, TL and primary care, and TL by other names. TL is likely occurring but going unrecognized in some settings.

“Who else is left?” the attending wearily asks toward the end of our morning rounds.

“Adena,” I respond, knowing no further summary is needed given her 2 months and counting with us.

Adena

Thirty-three years with multiple co-morbidities. On dialysis thanks to complex Type 1 diabetes. Left leg amputated thanks to a deep tissue infection. Now under our care for a nasty wound on her hand, a persistent infection that requires our strongest intravenous antibiotics. We can only guess at her cardiac state, too fragile for an angiogram after a recent myocardial infarction.

Her medical notes are detailed. But the

I would like to thank Armendariz et al for their contribution to understanding the root characteristics of rounding interruptions inherent to medical learners in the inpatient teaching environment.¹ As noted in the study conclusion, proactive communication with nursing staff holds merit for most team-based improvement strategies. However, based on anecdotal experience, simple discussions with nursing staff resulted in trivial long-term change. An effective, actionable plan is needed for residency programs to address inappropriately timed pages and improve paging etiquette during inpatient rounding.

Inpatient medicine has trended toward algorithmic-based patient care under the banners of improved patient outcomes and