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Bragazzi NL, Khabbache H, Ouazizi K, Ait Ali D, El Ghouat H, El Alami L, Atwan H, Tuma R, Dickman N, Farah R, Khamisy-Farah R. Key Learnings and Perspectives of a Newly Implemented Sex-and Gender-Based Medicine Modular Course Integrated into the First-Year Medical School Curriculum: A Mixed-Method Survey. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:685-693. [PMID: 39050118 PMCID: PMC11268626 DOI: 10.2147/amep.s447843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
Purpose Sex and Gender-Based Medicine (SGBM) addresses the influence of sex and gender on health and healthcare, emphasizing personalized care. Integrating SGBM into medical education is challenging. This study examines the implementation of an SGBM course in an Israeli university during the first year of the medical school. Methods The course integrated lectures, group work, online gender studies resources, workshops, teacher training, and essential literature. The curriculum spanned pre-clinical and clinical aspects, featuring seven 90-minute sessions. Surveys assessed course structure, content, and lecturers using a 5-point Likert scale and qualitative feedback. Quantitative analysis involved descriptive statistics, and thematic analysis was used for qualitative data. Results Of the 84 students surveyed, 35 (41.7%) responded to the first part, and 30 (35.7%) to the second. The SGBM course received high satisfaction with an average score of 3.63, surpassing other first-year courses (average 3.21). Students appreciated the supportive academic atmosphere (mean score 4.20) and diverse teaching methods (mean score 4.03), while the development of feminist thinking was less appreciated (average score 3.49). Lecturers received high ratings (average score 4.33). Qualitative feedback highlighted the value of group work, the significance of the subject matter, and the helpfulness of supplementary videos. Students requested more content on contemporary issues like gender transition and patient perspectives. The feminist medicine aspect was contentious, with students seeking better gender balance and scientific evidence. Conclusion Introducing SGBM into the first-year curriculum yielded positive results with high student satisfaction for content and lecturers. An expanded course module is planned, to be assessed at the end of the next academic year.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Human Nutrition Unit (HNU), Department of Food and Drugs University of Parma, Parma, Italy
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair, Health Anthropology Biosphere and Healing Systems, University of Genoa, Genoa, Italy
| | - Hicham Khabbache
- Director of the UNESCO Chair “Lifelong Learning Observatory” (UNESCO/UMSBA), Fez, Morocco
| | - Khalid Ouazizi
- Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Driss Ait Ali
- Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hanane El Ghouat
- Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Laila El Alami
- Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hisham Atwan
- Department of Internal Medicine, Kaplan Medical Centre, Hebrew University, Rehovot, Israel
| | - Ruba Tuma
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Galilee, Israel
- Clalit Health Services, Akko, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Nomy Dickman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Raymond Farah
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Internal Medicine B, Ziv Medical Center, Safed, Israel
| | - Rola Khamisy-Farah
- Clalit Health Services, Akko, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Carrillo I, Serpa P, Landa-Ramírez E, Guilabert M, Gómez-Ayala Y, López-Pineda A, Mira JJ. Speaking Up About Patient Safety, Withholding Voice and Safety Climate in Clinical Settings: a Cross-Sectional Study Among Ibero-American Healthcare Students. Int J Public Health 2024; 69:1607406. [PMID: 39011389 PMCID: PMC11246871 DOI: 10.3389/ijph.2024.1607406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
Objectives To explore speaking up behaviours, barriers to openly expressing patient safety concerns, and perceived psychological safety climate in the clinical setting in which healthcare trainees from Ibero-America were receiving their practical training. Methods Cross-sectional survey of healthcare trainees from Colombia, Mexico, and Spain (N = 1,152). Before the field study, the Speaking Up About Patient Safety Questionnaire (SUPS-Q) was translated into Spanish and assessed for face validity. A confirmatory factor analysis was conducted to establish the construct validity of the instrument, and the reliability was assessed. The SUPS-Q was used to evaluate voice behaviours and the perceived psychological safety climate among Ibero-American trainees. Descriptive and frequency analyses, tests for contrasting means and proportions, and logistic regression analyses were performed. Results Seven hundred and seventy-one trainees had experience in clinical settings. In the previous month, 88.3% had experienced patient safety concerns, and 68.9% had prevented a colleague from making an error. More than a third had remained silent in a risky situation. Perceiving concerns, being male or nursing student, and higher scores on the encouraging environment scale were associated with speaking up. Conclusion Patient safety concerns were frequent among Ibero-American healthcare trainees and often silenced by personal and cultural barriers. Training in speaking up and fostering safe interprofessional spaces is crucial.
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Affiliation(s)
- Irene Carrillo
- Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
| | - Piedad Serpa
- Department of Clinical Management and Patient Safety, School of Medicine, Universidad de Santander, Bucaramanga, Colombia
| | - Edgar Landa-Ramírez
- Facultad de Psicología, National Autonomous University of Mexico, Mexico City, Mexico
- Programa de Psicología Urgencias, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, Mexico
| | - Mercedes Guilabert
- Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
| | - Yesenia Gómez-Ayala
- Facultad de Psicología, National Autonomous University of Mexico, Mexico City, Mexico
| | - Adriana López-Pineda
- Clinical Medicine Department, School of Medicine, Miguel Hernández University of Elche, Elche, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - José Joaquín Mira
- Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
- ATENEA Research Group, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
- Alicante-Sant Joan Health District, Alicante, Spain
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Skan O, Tregidgo L, Tizzard J, Westlake I, Joji N. Examining medical students' experience of gender-based discrimination and sexual harassment from clinical teachers at a UK medical school. MEDICAL TEACHER 2024:1-9. [PMID: 38564885 DOI: 10.1080/0142159x.2024.2331034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF THE ARTICLE To quantify the prevalence and characterise the nature of gender-based discrimination (GBD) and sexual harassment (SH) arising from clinical teachers towards medical students at one UK medical school. MATERIALS AND METHODS A mixed quantitative and qualitative survey of medical students. Chi-squared analysis and logistic regression was performed on quantitative data, while an inductive thematic analysis of qualitative data was undertaken. These findings were compared to look for common patterns. RESULTS Females were significantly more likely to report experiencing both GBD (χ2 = 38.61, p < 0.0001) and SH (χ2 = 19.53, p < 0.0001) than males (OR = 10.45 (CI 4.84 - 22.56, p < 0.0001)). These behaviours were more likely to be reported in specific surgical placements than medical placements (χ2 = 15.06, p < 0.001 and χ2 = 5.90, p < 0.05). Perpetrators were more commonly male, and more commonly consultants. Exposure to GBD or SH was significantly more likely to affect the choice of specialty in females compared to males (χ2 = 11.17, p < 0.001). Students noted a casual use of sexist language, inappropriate sexual advances, and gender-based microaggressions which create a pervasive discrepancy in educational opportunities between genders. Participants reported that concerns regarding anonymity, questioning the severity of the incident, and an ingrained medical hierarchy prevented students reporting these incidents. CONCLUSIONS The rate of GBD and SH from clinical teachers to medical students remains high, affecting female students more than male students. This study highlights key areas that must be improved to achieve a more equitable teaching experience in UK medical schools. Developing robust reporting and support systems is an important step in eradicating these behaviours.
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Affiliation(s)
- Oliver Skan
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Laura Tregidgo
- Medical Sciences Division, University of Oxford, United Kingdom
| | - James Tizzard
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Isabel Westlake
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Nikita Joji
- Royal Free London NHS Trust, London, United Kingdom
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Longhurst GJ, Bazira PJ, Finn GM. Student's perspectives of inclusive practices in anatomy education. ANATOMICAL SCIENCES EDUCATION 2024; 17:571-590. [PMID: 38372435 DOI: 10.1002/ase.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
There is a drive to implement inclusive practices in anatomy by adapting curricula and utilizing inclusive language and resources that negate biases. However, to date there is no data regarding student's perception of inclusivity. Therefore, the study aims to investigate anatomy student's opinions on inclusive practices in anatomy education based on the protected characteristics of age, disability, ethnicity, gender affirmation and sex. One hundred and forty-five students completed a questionnaire with 21 Likert-scale and two open-ended questions. Kruskal-Wallis tests compared responses by groups defined by the protected characteristics of the Equality Act (2010). Most students (71.2%; n = 84) agreed or strongly agreed that "improving inclusivity in anatomy education should be educator's priority". In terms of representation, there was a statistically different response rate from students from different ethnic backgrounds to the statements "there are anatomy educators" (p < 0.001), "images in textbooks" (p < 0.001) and "models in the dissection room" (p < 0.001) "that look like me". Most students agreed or strongly agreed to statements relating to the protected characteristics of age (70.4%; n = 68), disability (78.6%; n = 77), ethnicity (59.8%; n = 64), gender affirmation (46.3%; n = 46) and sex (51.5%; n = 62). Themes identified relating to improving inclusivity included "reflecting reality", "teaching the truth", "the invisibility of women" and the "learning environment". Students have confirmed that anatomists, as gatekeepers of the knowledge of the human body, should foster inclusive teaching practices that will benefit all students and potentially future patient care.
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Affiliation(s)
| | - Peter J Bazira
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | - Gabrielle Maria Finn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Hauer KE, Park YS, Bullock JL, Tekian A. "My Assessments Are Biased!" Measurement and Sociocultural Approaches to Achieve Fairness in Assessment in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S16-S27. [PMID: 37094278 DOI: 10.1097/acm.0000000000005245] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Assessing learners is foundational to their training and developmental growth throughout the medical education continuum. However, growing evidence shows the prevalence and impact of harmful bias in assessments in medical education, accelerating the urgency to identify solutions. Assessment bias presents a critical problem for all stages of learning and the broader educational system. Bias poses significant challenges to learners, disrupts the learning environment, and threatens the pathway and transition of learners into health professionals. While the topic of assessment bias has been examined within the context of measurement literature, limited guidance and solutions exist for learners in medical education, particularly in the clinical environment. This article presents an overview of assessment bias, focusing on clinical learners. A definition of bias and its manifestations in assessments are presented. Consequences of assessment bias are discussed within the contexts of validity and fairness and their impact on learners, patients/caregivers, and the broader field of medicine. Messick's unified validity framework is used to contextualize assessment bias; in addition, perspectives from sociocultural contexts are incorporated into the discussion to elaborate the nuanced implications in the clinical training environment. Discussions of these topics are conceptualized within the literature and the interventions used to date. The article concludes with practical recommendations to overcome bias and to develop an ideal assessment system. Recommendations address articulating values to guide assessment, designing assessment to foster learning and outcomes, attending to assessment procedures, promoting continuous quality improvement of assessment, and fostering equitable learning and assessment environments.
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Affiliation(s)
- Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards, and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8812-4045
| | - Yoon Soo Park
- Y.S. Park is associate professor and associate head, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335
| | - Justin L Bullock
- J.L. Bullock is a fellow, Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Seattle, Washington; ORCID: http://orcid.org/0000-0003-4240-9798
| | - Ara Tekian
- A. Tekian is professor and associate dean for international education, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-9252-1588
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Politis M, El Brown M, Huser CA, Crawford L, Pope L. 'I wouldn't know what to do with the breasts': the impact of patient gender on medical student confidence and comfort in clinical skills. EDUCATION FOR PRIMARY CARE 2022; 33:316-326. [PMID: 36443928 DOI: 10.1080/14739879.2022.2129460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous research has found a relationship between students' gender and attitudes surrounding peer physical examination, but relationship between patient gender and confidence/comfort is less clear. We explored whether patient gender affects medical students' levels of confidence and comfort in clinical examination skills. METHODS An electronic survey and focus groups were conducted with medical students from one UK institution. Students reported levels of confidence/comfort when carrying out clinical examinations on men/women. An inductive thematic analysis was performed. RESULTS Of a total of 1500 students provided with the opportunity to participate, ninety (6%) responded. For cardiovascular and respiratory examinations, confidence/comfort were higher when examining male-presenting patients. The opposite was true for mental state examinations. Barriers to confidence/comfort included perceiving males as a norm, difficulty navigating breasts, tutors' internalised gendered attitudes and a wider sociocultural issue. Facilitators of confidence/comfort included students relating to patients, embodying a professional role, gender blindness, and authentic clinical environments. Fewer than 20% (n = 18) of students felt they had enough opportunity to practice clinical skills on women, versus 90% (n = 82) on men. CONCLUSION Our study identified an area where students' confidence and comfort in clinical examinations could be enhanced within medical education. Changes were implemented in the institution under study's vocational skills teaching, which is rooted in general practice. Information on gender and clinical skills was provided within course handbooks, time was scheduled to discuss gender and clinical skills in small group settings, and equitable gender representation was ensured in clinical assessment.
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Affiliation(s)
- Marina Politis
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Megan El Brown
- Buckingham Medical School, Buckingham Medical School, University of Buckingham, Buckingham, UK.,Medical Education Innovation and Education Centre (MEdIC), Imperial College London, London, UK
| | - Camille Am Huser
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Lynsay Crawford
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Lindsey Pope
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
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Finn GM, Brown MEL. Ova-looking feminist theory: a call for consideration within health professions education and research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:893-913. [PMID: 35389154 PMCID: PMC8988912 DOI: 10.1007/s10459-022-10108-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
The role of feminist theory in health professions education is often 'ova-looked'. Gender is one cause of healthcare inequalities within contemporary medicine. Shockingly, according to the World Health Organisation, no European member state has achieved full gender equity in regard to health outcomes. Further, contemporary curricula have not evolved to reflect the realities of a diverse society that remains riddled with inequity. This paper outlines the history of feminist theory, and applies it to health professions education research and teaching, in order to advocate for its continued relevance within contemporary healthcare.
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Affiliation(s)
- G M Finn
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - M E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
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8
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Adar R, Kahalon R, Ullrich J, Afek A, Eisenberg VH. Gender bias in the evaluation of interns in different medical specialties: An archival study. MEDICAL TEACHER 2022; 44:893-899. [PMID: 35316160 DOI: 10.1080/0142159x.2022.2046715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The field of medicine is characterized by within-field gender segregation: Gender ratios vary systematically by subdisciplines. This segregation might be, in part, due to gender bias in the assessment of women and men medical doctors. METHODS We examined whether the assessments, i.e. overall score, department scores and skills scores, interns receive by their superiors during their internship year, vary as a function of their gender and the representation of women in the field. We analyzed an archival data set from a large hospital in Israel which included 3326 assessments that were given to all interns who completed their internship year between 2015 and 2019. RESULTS Women received lower department scores and skills scores in fields with a low (versus high) representation of women. Men received higher scores in fields with a high (versus low) representation of men, yet there was no difference in their skills scores. CONCLUSIONS Women are evaluated more negatively in fields with a low representation of women doctors. Similarly, men are evaluated more negatively in fields with a low representation of men, yet this cannot be explained by their skills. This pattern of results might point to a gender bias in assessments. A better understanding of these differences is important as assessments affect interns' career choices and options.
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Affiliation(s)
- Roy Adar
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel
| | - Rotem Kahalon
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychology, Simon Fraser University, Canada
| | - Johannes Ullrich
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Arnon Afek
- Management & research unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Vered H Eisenberg
- Management & research unit, Sheba Medical Center, Tel Hashomer, Israel
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9
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Finn GM, Crampton P, Buchanan JA, Balogun AO, Tiffin PA, Morgan JE, Taylor E, Soto C, Kehoe A. The impact of the COVID-19 pandemic on the research activity and working experience of clinical academics, with a focus on gender and ethnicity: a qualitative study in the UK. BMJ Open 2022; 12:e057655. [PMID: 35676023 PMCID: PMC9184994 DOI: 10.1136/bmjopen-2021-057655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the impact of the COVID-19 pandemic on the research activity and working experience of clinical academics, with a focus on gender and ethnicity. DESIGN Qualitative study based on interviews and audio/written diary data. SETTING UK study within clinical academia. PARTICIPANTS Purposive sample of 82 clinical academics working in medicine and dentistry across all career stages ranging from academic clinical fellows and doctoral candidates to professors. METHODS Qualitative semistructured interviews (n=68) and audio diary data (n=30; including 16 participants who were also interviewed) collected over an 8-month period (January-September 2020), thematically analysed. RESULTS 20 of 30 (66.6%) audio diary contributors and 40 of 68 (58.8%) interview participants were female. Of the participants who disclosed ethnicity, 5 of 29 (17.2%) audio diary contributors and 19/66 (28.8%) interview participants identified as Black, Asian or another minority (BAME). Four major themes were identified in relation to the initial impact of COVID-19 on clinical academics: opportunities, barriers, personal characteristics and social identity, and fears and uncertainty. COVID-19 presented opportunities for new avenues of research. Barriers included access to resources to conduct research and the increasing teaching demands. One of the most prominent subthemes within 'personal characteristics' was that of the perceived negative impact of the pandemic on the work of female clinical academics. This was attributed to inequalities experienced in relation to childcare provision and research capacity. Participants described differential experiences based upon their gender and ethnicity, noting intersectional identities. CONCLUSIONS While there have been some positives afforded to clinical academics, particularly for new avenues of research, COVID-19 has negatively impacted workload, future career intentions and mental health. BAME academics were particularly fearful due to the differential impact on health. Our study elucidates the direct and systemic discrimination that creates barriers to women's career trajectories in clinical academia. A flexible, strategic response that supports clinical academics in resuming their training and research is required. Interventions are needed to mitigate the potential lasting impact on capacity from the pandemic, and the potential for the loss of women from this valuable workforce.
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Affiliation(s)
- Gabrielle M Finn
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Paul Crampton
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - John Ag Buchanan
- Centre for Education and Innovation, Barts and The London School of Medicine and Dentistry, London, UK
| | | | | | - Jessica Elizabeth Morgan
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ellie Taylor
- Health Professions Education Unit, Hull York Medical School, York, UK
| | | | - Amelia Kehoe
- Health Professions Education Unit, Hull York Medical School, York, UK
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Muldoon KM. IMPROVing communication about diversity, equity, and inclusion in health professions education. Anat Rec (Hoboken) 2022; 305:1000-1018. [PMID: 35103421 DOI: 10.1002/ar.24864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 12/22/2022]
Abstract
There has never been a stronger call for authenticity in health professions education than this moment in time. The health inequities laid bare by the COVID-19 syndemic (a concept that describes the clustering of SARS-CoV-2 infection and disease by political, social, and economic factors) compels health professions educators to learn how to best engage in, sustain, and deepen conversations on diversity, equity, and inclusion (DEI) within our learning environments. Health professions curricula should address such concerns through explicit faculty training programs in dialogue models of communication. In this commentary, I propose that medical improv can help refocus health professions training to the humanistic values of empathy for others and respect for multiple viewpoints. Medical improv refers to teaching methods that adapt improvisation principles and exercises to enhance professional competencies in the health professions, such as communication. I describe a training series implemented at one institution to prepare faculty facilitators to engage in conversations about DEI in a discussion-based core course on the social determinants of health for first year medical students called "Humanity in Medicine." Key elements of dialogue training, including examinations of identity and positionality, caretaking and team-making, and conversations with a skeptic, are viewed through the lens of improv exercises as a pedagogy in communication. I report on facilitator and medical students' positive response to facilitator training and the Humanity in Medicine course. Potential next steps towards a formal evaluation of the method, and outcomes assessments of the use of improv in health professions training are discussed.
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Affiliation(s)
- Kathleen M Muldoon
- Department of Anatomy, College of Graduate Studies and Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
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George R, Utunen H, Ndiaye N, Tokar A, Mattar L, Piroux C, Gamhewage G. Ensuring equity in access to online courses: Perspectives from the WHO health emergency learning response. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Richelle George
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Heini Utunen
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Ngouille Ndiaye
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Anna Tokar
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Lama Mattar
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Corentin Piroux
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Gaya Gamhewage
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
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Affiliation(s)
- Adam Danquah
- Faculty of Biology, Medicine, and Health, University of Manchester, M13 9PL
| | - Gabrielle Finn
- Faculty of Biology, Medicine, and Health, University of Manchester, M13 9PL
| | - Margaret Kingston
- Faculty of Biology, Medicine, and Health, University of Manchester, M13 9PL
| | - Oyebanji Adewumi
- Faculty of Biology, Medicine, and Health, University of Manchester, M13 9PL
| | - Graham Lord
- Faculty of Biology, Medicine, and Health, University of Manchester, M13 9PL
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13
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Kollu T, Giutashvili T, Uppal P, Ruffner R, Mortensen M. Diversity in Academic Laryngology: An Evaluation of Academic Advancement and Research Productivity. Laryngoscope 2021; 132:1245-1250. [PMID: 34726277 DOI: 10.1002/lary.29918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Diversity within the medical profession with respect to sex and racial minorities has been shown to have a positive effect on health and healthcare. Characterization of a field is key to evaluating trends and the advancement of diversity in an otolaryngology subspecialty. STUDY DESIGN Observational study. METHODS A comprehensive list of all the academic laryngologists was compiled from the Accreditation Council for Graduate Medical Education accredited otolaryngology residency programs in 2020. The last 20 past presidents of the American Laryngological Association (ALA) and American Broncho-Esophogological Association (ABEA) were analyzed. Academic rank and years in practice were determined from departmental websites, with online search tools used as secondary resources. The h-index was utilized as a measure of research productivity. Regression analysis was performed to analyze these variables. RESULTS There are 184 academic laryngologists in the 124 programs. The majority of the population is Caucasian 76.6% (141/184), followed by Asian 16.3% (30/184), African American 4.34% (8/184), and then Hispanic 1% (2/184). There are 47 full professors with 83% Caucasian, 14.1% Asian, and 2.1% African American and 91.5% male and only 8.5% female. Past ALA presidents were 90% male and for the ABEA 75% male. H-index revealed a statistically significant difference between Caucasian and African American colleagues [P value (<.0005)]. CONCLUSIONS Minorities are disproportionately underrepresented in laryngology. Women are less likely to be in leadership roles in laryngology and become full professors. Laryngology lags behind other surgical specialties in the representation of minorities and women. Continued efforts should be made to increase diversity in the field of laryngology, especially in regard to underrepresented minorities. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Tejas Kollu
- Department of Otolaryngology, Albany Medical Center, Albany, New York, U.S.A
| | | | - Priya Uppal
- Department of Otolaryngology, Albany Medical Center, Albany, New York, U.S.A
| | - Randall Ruffner
- Department of Otolaryngology, Albany Medical Center, Albany, New York, U.S.A
| | - Melissa Mortensen
- Department of Otolaryngology, Albany Medical Center, Albany, New York, U.S.A
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14
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Finn GM, Quinn R, Sanders K, Ballard W, Balogun-Katung A, Dueñas AN. Pandemics, Protests, and Pronouns: The Changing Landscape of Biomedical Visualisation and Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1334:39-53. [PMID: 34476744 DOI: 10.1007/978-3-030-76951-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Events in early 2020 changed the landscape of education for the foreseeable future, perhaps permanently. Three events had a significant impact; (1) the Coronavirus disease 2019 (COVID-19) pandemic, (2) the death of George Floyd, which resulted in the most recent Black Lives Matter (BLM) protests, and (3) the Twitter storm, the resultant societal fallout and freedom of speech campaigns, following comments made by author JK Rowling which many deemed transphobic. These events had a differential impact on biomedical sciences, when compared to other sectors. COVID-19 resulted in a global lockdown, with higher education institutions closing campuses and moving to online-only delivery. This rapid change required radical shifts in the use of technology, with mass delivery of teaching at short notice. The BLM protests further raised awareness of the inequalities within society, particularly those experienced by Black people and other oppressed groups. As a result, there have been calls for the decolonisation of the curriculum. The implications of these three key events have led institutions to rethink their policies, teaching delivery, assessment, curricula, and physical environments. This chapter considers (1) the implications of a swift change in the primary mode of curriculum delivery within Higher Education to online formats and (2) how recent adverse events have resulted in calls for much-needed changes in visual representations within biomedical sciences. Finally, we consider (3) the role of the hidden curriculum and the potential impact of visual representations in curricula on the delivery of healthcare and the fight against health inequalities, which are often as a result of implicit biases. The year 2020 has proven timely in presenting the opportunity for change, provided through the power of imagery.
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Affiliation(s)
- Gabrielle M Finn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Rebecca Quinn
- Hull York Medical School, University of Hull, Hull, UK
| | - Katherine Sanders
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, UK
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15
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Szymczak JE. Structural Factors, Power, and the Physician Sex Pay Gap. JAMA Pediatr 2021; 175:868. [PMID: 33999099 DOI: 10.1001/jamapediatrics.2021.0870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Julia E Szymczak
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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16
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Champagne-Langabeer T, Hedges AL. Physician gender as a source of implicit bias affecting clinical decision-making processes: a scoping review. BMC MEDICAL EDUCATION 2021; 21:171. [PMID: 33740973 PMCID: PMC7980423 DOI: 10.1186/s12909-021-02601-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/08/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND The demographic profile of practicing physicians is changing as more female medical students are graduating and practicing in the field. While the education received may not differ by gender, studies have shown that physician practice outcomes vary by provider gender. Various factors could contribute to these differences, including culture and explicit biases which may lead to implicit bias. This study aims to identify the available evidence of gender-based implicit bias throughout the delivery process of medicine. METHODS This scoping review evaluated published literature within the PubMed, Ovid MEDLINE, PsychINFO, Web of Science, and BioMed Central databases pertaining to physician's gender as a factor in the delivery of medicine. Arksey and O'Malley's six-stage methodology was used as a framework and reported using the updated Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches occurred between May 2020 and June 2020, and the timeframe was not limited. Included articles had gender as a factor in the delivery of medicine and implicit bias. Articles were excluded if they did not include the gender of the physician. After screening by reviewers and a medical librarian, study characteristics were charted and analyzed. RESULTS The initial search resulted in 2420 records. After screening, 162 of the records were selected based on title and keyword relevance. After additional screening, 15 records were ultimately included in the review based on full-text evaluation. Records were organized into sub-topics post hoc focused on clinical qualities, diagnostics, treatment, and outcomes. CONCLUSION This scoping review found that gender-based implicit bias may be inadvertently acquired from culture and education. Although implicit bias is highly researched, much of the current literature focuses on the gender of the patient. This study found important gaps in the available literature regarding race and gender of the physician. Further studies could explore outcome differences between recent graduates and career physicians, for both female and male physicians.
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Affiliation(s)
- Tiffany Champagne-Langabeer
- School of Biomedical Informatics, The University of Texas Health Science Center, 7000 Fannin Street, Suite 600, Houston, TX, USA.
| | - Andrew L Hedges
- School of Biomedical Informatics, The University of Texas Health Science Center, 7000 Fannin Street, Suite 600, Houston, TX, USA
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