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Onumah CM, Pincavage AT, Lai CJ, Levine DL, Ismail NJ, Alexandraki I, Osman NY. Strategies for Advancing Equity in Frontline Clinical Assessment. Acad Med 2023; 98:S57-S63. [PMID: 37071692 DOI: 10.1097/acm.0000000000005246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Educational equity in medicine cannot be achieved without addressing assessment bias. Assessment bias in health professions education is prevalent and has extensive implications for learners and, ultimately, the health care system. Medical schools and educators desire to minimize assessment bias, but there is no current consensus on effective approaches. Frontline teaching faculty have the opportunity to mitigate bias in clinical assessment in real time. Based on their experiences as educators, the authors created a case study about a student to illustrate ways bias affects learner assessment. In this paper, the authors use their case study to provide faculty with evidence-based approaches to mitigate bias and promote equity in clinical assessment. They focus on 3 components of equity in assessment: contextual equity, intrinsic equity, and instrumental equity. To address contextual equity, or the environment in which learners are assessed, the authors recommend building a learning environment that promotes equity and psychological safety, understanding the learners' contexts, and undertaking implicit bias training. Intrinsic equity, centered on the tools and practices used during assessment, can be promoted by using competency-based, structured assessment methods and employing frequent, direct observation to assess multiple domains. Instrumental equity, focused on communication and how assessments are used, includes specific, actionable feedback to support growth and use of competency-based narrative descriptors in assessments. Using these strategies, frontline clinical faculty members can actively promote equity in assessment and support the growth of a diverse health care workforce.
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Affiliation(s)
- Chavon M Onumah
- C.M. Onumah is associate professor, Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Amber T Pincavage
- A.T. Pincavage is professor, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Cindy J Lai
- C.J. Lai is professor and director of medical student clinical education, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Diane L Levine
- D.L. Levine is professor and vice chair for education, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Nadia J Ismail
- N.J. Ismail is professor, Department of Medicine and Department of Education, Innovation and Technology, and vice dean, Baylor College of Medicine, Houston, Texas
| | - Irene Alexandraki
- I. Alexandraki is professor and senior associate dean, academic affairs, Office of Academic Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Nora Y Osman
- N.Y. Osman is associate professor, Harvard Medical School, and director of undergraduate medical education, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Gonzalez CM, Onumah CM, Walker SA, Karp E, Schwartz R, Lypson ML. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. Adv Health Sci Educ Theory Pract 2023; 28:541-587. [PMID: 36534295 DOI: 10.1007/s10459-022-10168-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
One criticism of published curricula addressing implicit bias is that few achieve skill development in implicit bias recognition and management (IBRM). To inform the development of skills-based curricula addressing IBRM, we conducted a scoping review of the literature inquiring, "What interventions exist focused on IBRM in professions related to social determinants of health: education, law, social work, and the health professions inclusive of nursing, allied health professions, and medicine?"Authors searched eight databases for articles published from 2000 to 2020. Included studies: (1) described interventions related to implicit bias; and (2) addressed knowledge, attitude and/or skills as outcomes. Excluded were interventions solely focused on reducing/neutralizing implicit bias. Article review for inclusion and data charting occurred independently and in duplicate. Investigators compared characteristics across studies; data charting focused on educational and assessment strategies. Fifty-one full-text articles for data charting and synthesis, with more than 6568 learners, were selected. Educational strategies included provocative/engagement triggers, the Implicit Association Test, reflection and discussion, and various active learning strategies. Most assessments were self-report, with fewer objective measures. Eighteen funded studies utilized federal, foundation, institutional, and private sources. This review adds to the literature by providing tangible examples of curricula to complement existing frameworks, and identifying opportunities for further research in innovative skills-based instruction, learner assessment, and development and validation of outcome metrics. Continued research addressing IBRM would enable learners to develop and practice skills to recognize and manage their implicit biases during clinical encounters, thereby advancing the goal of improved, equitable patient outcomes.
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Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
| | - Chavon M Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sydney A Walker
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elisa Karp
- Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA
| | | | - Monica L Lypson
- Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Pincavage AT, Osman NY, Alexandraki I, Ismail NJ, Levine DL, Onumah CM, Lai CJ. AAIM Recommendations to Promote Equity in the Clerkship Clinical Learning Environment. Am J Med 2022; 135:1021-1028. [PMID: 35504324 DOI: 10.1016/j.amjmed.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Irene Alexandraki
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso
| | - Nadia J Ismail
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Diane L Levine
- Department of Medicine, Wayne State University School of Medicine, Detroit, Mich
| | - Chavon M Onumah
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Cindy J Lai
- Department of Medicine, University of California, San Francisco, School of Medicine
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Onumah CM, Lai CJ, Levine D, Ismail N, Pincavage AT, Osman NY. Aiming for Equity in Clerkship Grading: Recommendations for Reducing the Effects of Structural and Individual Bias. Am J Med 2021; 134:1175-1183.e4. [PMID: 34144012 DOI: 10.1016/j.amjmed.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Chavon M Onumah
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Cindy J Lai
- Department of Medicine, University of California, San Francisco, School of Medicine
| | - Diane Levine
- Department of Medicine, Wayne State University School of Medicine, Detroit, Mich
| | - Nadia Ismail
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amber T Pincavage
- Department of Medicine, University of Chicago Pritzker School of Medicine, Ill
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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Onumah CM, Gonzaga AMR, Yialamas MA. In Reply to Bowe et al. Acad Med 2021; 96:481-482. [PMID: 33782232 DOI: 10.1097/acm.0000000000003933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Chavon M Onumah
- Assistant professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC;
| | - Alda Maria R Gonzaga
- Associate professor, Departments of Medicine and Pediatrics, and associate dean for student affairs, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Maria A Yialamas
- Assistant professor, Harvard Medical School, and associate program director, Brigham and Women's Hospital Internal Medicine Residency, Boston, Massachusetts
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Gonzaga AMR, Appiah-Pippim J, Onumah CM, Yialamas MA. A Framework for Inclusive Graduate Medical Education Recruitment Strategies: Meeting the ACGME Standard for a Diverse and Inclusive Workforce. Acad Med 2020; 95:710-716. [PMID: 31702694 DOI: 10.1097/acm.0000000000003073] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To help address health care disparities and promote higher-quality, culturally sensitive care in the United States, the Accreditation Council for Graduate Medical Education and other governing bodies propose cultivating a more diverse physician workforce. In addition, improved training and patient outcomes have been demonstrated for diverse care teams. However, prioritizing graduate medical education (GME) diversity and inclusion efforts can be challenging and unidimensional diversity initiatives typically result in failure.Little literature exists regarding actionable steps to promote diversity in GME. Building on existing literature and the authors' experiences at different institutions, the authors propose a 5-point inclusive recruitment framework for diversifying GME training programs. This article details each of the 5 steps of the framework, which begins with strong institutional support by setting diversity as a priority. Forming a cycle, the other 4 steps are seeking out candidates, implementing inclusive recruitment practices, investing in trainee success, and building the pipeline. Practical strategies for each step and recommendations for measurable outcomes for continued support for this work are provided. The proposed framework may better equip colleagues and leaders in academic medicine to prioritize and effectively promote diversity and inclusion in GME at their respective institutions.
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Affiliation(s)
- Alda Maria R Gonzaga
- A.M.R. Gonzaga is associate professor, Departments of Medicine and Pediatrics, and medicine-pediatrics residency program director, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. J. Appiah-Pippim is associate professor, Department of Medicine, AU/UGA Medical Partnership, and program director, Transitional Year Residency, Piedmont Athens Regional, Athens, Georgia. C.M. Onumah is assistant professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC. M.A. Yialamas is assistant professor, Harvard Medical School, and associate program director, Brigham and Women's Hospital Internal Medicine Residency, Boston, Massachusetts
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Sola O, Kothari P, Mason HRC, Onumah CM, Sánchez JP. The Crossroads of Health Policy and Academic Medicine: An Early Introduction to Health Policy Skills to Facilitate Change. MedEdPORTAL 2019; 15:10827. [PMID: 31161139 PMCID: PMC6543861 DOI: 10.15766/mep_2374-8265.10827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/08/2019] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Despite significant health care reform in the past 10 years, health disparities persist in marginalized and low-resource communities. Although there are a lot of reasons for health disparities, many of which are not related to health care, changes in health policy can lead to improved health equity. Redefining health policy as an important aspect of medical education could popularize the teaching and application of health policy competencies within academic health centers. METHODS The Kern model was applied to develop a workshop to educate medical students on basic health policy concepts and opportunities for them to apply a health policy framework to facilitate organizational change. Specifically, the workshop helped trainees to define common concepts in health policy, to understand a framework for developing policy initiatives, and to identify areas of overlap between health policy and academic medicine. Instructional methods included a PowerPoint presentation, vignette-based small-group discussion, and career reflection. RESULTS The workshop was implemented at three national conferences with a total of 144 participants. Comparing pre- and postworkshop survey responses, participants felt health policy work was compatible with an academic medicine career. Over 95% of respondents agreed or strongly agreed that each objective had been met. DISCUSSION By viewing health policy through the lens of academia, trainees were able to develop a new appreciation for how health policy activities can contribute to peer-reviewed publications, teaching, and leadership opportunities. Participants were better situated to integrate health policy skills in their academic or nonacademic careers.
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Affiliation(s)
- Orlando Sola
- Assistant Clinical Professor, Department of Family Medicine, SUNY-Downstate Medical Center
- Associate Clerkship Director, Primary Care, SUNY-Downstate Medical Center
| | - Pooja Kothari
- Third-Year Medical Student, Rutgers New Jersey Medical School
| | - Hyacinth R. C. Mason
- Assistant Dean, Student Support and Inclusion, Albany Medical College
- Associate Professor, Department of Medical Education, Albany Medical College
- Associate Professor, Department of Family and Community Medicine, Albany Medical College
| | - Chavon M. Onumah
- Director, Primary Care Clerkship, George Washington University School of Medicine and Health Sciences
- Co-Director, HIV in Internal Medicine Pathway, George Washington University School of Medicine and Health Sciences
- Assistant Professor of Medicine, General Internal Medicine, George Washington University School of Medicine and Health Sciences
| | - John Paul Sánchez
- Associate Dean, Diversity and Inclusion, Rutgers New Jersey Medical School
- Associate Professor, Emergency Medicine, Rutgers New Jersey Medical School
- Director, LMSA National
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