Time Stamps

• 02:08 Make it Stick Virtually
• 08:50 Mentoring in the Modern Era: More than the Traditional Dyad
• 13:29 Clinical Update in Medical Education
• 21:04 Anti-Racism in Medical Education: Concrete Actions to Further Social Justice and Racial Equity

Show Notes

Make it Stick Virtually

Drs. Andrew Klein, Rebeca Ortiz-Worthington, Michael Simonson, Andrew Carter, Allie Dakroub and Melissa McNeil

• 3 components of effective note-taking
  • Handwritten notes are better than typed notes. A study demonstrated that students who take notes by hand have a statistically significant greater ability to cognitively process and understand conceptual knowledge
  • Non verbatim notes are better than verbatim notes, as it also forces cognitive engagement with the information
  • Notes are more powerful when combined with retrieval, the process of repeated self-testing of knowledge to strengthen recall memory and learning
• Clinical teaching is interleaved and spaced
  • Interleaving is the technique of alternating between different topics to improve learning, which happens commonly during rounds, when we see different patients with different diagnoses.
  • Spacing happens when we learn one aspect of a disease one day, and another aspect another day, creating repeated review of a concept over time.

Mentoring in the Modern Era: More than the Traditional Dyad

Drs. Maria Wamsly, Bernice Ruo and Subha Ramani 

• Peer mentorship allows to share lived experiences with colleagues that understand our challenges
• One way to add formality to a mentorship group is by using the 5/10/30 rule
  • Spend 5 minutes at the beginning just checking in on members, then 10 minutes to discuss short-term goals, then 30 minutes to discuss long-term goals and steps to achieve them.
  • Spend the last 15 minutes to wrap up the meeting
• Junior mentorship can be improved by having bi-directional feedback. In other words, asking learners for mentoring feedback may help the educator improve their mentoring skills.

Clinical Update in Medical Education

Drs. Maryann Overland, Tyler Albert and Paul Cornia, Megha Garg and  Mel Anderson  

• Point-of-care ultrasound (POCUS): Do portable ultrasound devices improve trainee ultrasound skills?
  • A study comparing internal medicine trainees with personal ultrasound devices and without showed no difference in the frequency of conducting POCUS exams and knowledge (assessed by multiple choice exam) between the two groups.
  •  Despite not being more competent, trainees with personal ultrasound devices displayed more confidence in using POCUS, with 17% and 50% of POCUS and control group respectively citing lack of confidence as a barrier, with a number needed to create false confidence of three.
  • Awareness of one’s limitations using POCUS is important to know how far you can interpret the information.
• Gender bias in clinical evaluations: Does implicit bias affect gender performance scores in clinical rotations?
  •  A cross-sectional study shows that female resident assessments peak and plateau while male resident assessments continue to improve throughout residency.
  • Indeed, women in traditionally male-dominated fields have to carefully balance being likable with being authoritative. As female residents gain leadership skills, independence and assertiveness, their professional roles and behaviors may not align with expectations of normative gender behaviors, resulting in unconscious bias and lower scores.
• Residents from minority groups: How common are biased patient behaviors?
  • BIPoC, LGBTQ and female trainees are routinely exposed to biased patient behaviors.
    • 99% of Asian residents have experienced being confused with another Asian team member at least once in the past year
    • Most women have experienced assumption of non-physician status.
    • 45% of Black and Latinx reported patient refusal of care and requests to change physicians.
  •  Most residents do not respond or report these biased behaviours, as many institutions have little accountability structures and residents may fear retaliation.
  • Residency programs have a responsibility to support residents and foster safe spaces at work.

Anti-Racism in Medical Education: Concrete Actions to Further Social Justice and Racial Equity

Drs. Sarah Merriam, Rachel Bonnema, Danielle Jones, Kate Lupton, Rani Nandiwada, Aditi Puri, Laura Snydman, Carla Spagnoletti and Eloho Ufomata

• Compelling Big Picture Points: Addressing structural factor
  • In many institutions, antiracism curriculum focuses on individual factors, such as unconscious bias and cultural competency. To avoid providing a superficial understanding of race, programs should also address structural factors.
  • In July 2021, the Internal Medicine Accreditation Council for Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LMCE) proposed a new core competency around structural racism, “Mastering the Effects of Structural Racism”, which would urge training programs to develop measurable learning objectives on structural racism.
• Immediate Action Points
  • Microaggressions can trigger stereotype threat, which represents fear of confirming a negative stereotype about an individual’s race or cultural group.
    • As these individuals change the way they speak or act to avoid discrimination (code-switching), the anxiety of stereotype threat can lead to decreased work performance and further isolation
    • Team leaders should foster an environment where trainees feel safe in their own identity and don’t feel the need to code switch.
  • Trainee assessment is often based on peer-to-peer comparison. To avoid bias, we should instead focus on the individual learner’s growth and patient care.
  • In order to promote antiracism work, faculty assessments should also include anti-racism measurements as part of annual progress review, thus allowing faculty members to reflect their contribution on diversity and inclusion.

Transcript

M: Welcome back to Core IM, this is Dr. Marty Fried, an academic primary care physician at THE Ohio State Wexner Medical Center, and I’m joined today by the dominator of the ventilator, the professor of the pressor, the baritone of prone himself – Dr. Tim Rowe.

T: Thanks Marty, I’ve truly missed your absurdity. And I’m glad to be back on the pod, coming to you now as a Pulm/Crit fellow at Northwestern in Chicago, but always a general internist at heart.  

M: So Tim and I, along with several of our Core IM producers, got a chance to virtually participate in the SGIM Annual Meeting in April 2021 and we are now excited to highlight some really remarkable content.

T: Right, over the next few weeks we here at Core IM will be distilling our favorite moments from SGIM into three action packed episodes covering material from many sessions. So buckle your seatbelts. Today, Marty and I will be reviewing some of our favorite medical education themed sessions.

M: Yeah and that was incredibly challenging because there was just so much good stuff at SGIM this year… I mean you could have – and we did – spend all day every day in and out of the Med Ed themed sessions. 

T: Yeah, honestly I felt so fortunate when Shreya was like Tim we need someone to cover Med Ed. The sessions we’re gonna highlight today are: (1) Making it Stick Virtually: Applying the Cognitive Science of Learning to Everyday Teaching (2) Mentoring in the Modern Era (3) Anti-Racism in Med Ed: Concrete Actions to Further Social Justice and (4) Clinical Update in Medical Education and Education Scholarship.  

M: So with that, Tim why don’t you get us started with Making it Stick Virtually.

Making it Stick Virtually

T: Yes! I love this session. It was put on by an all-star lineup from UPMC in Pittsburgh – Drs. Andrew Klein, Rebeca Ortiz-Worthington, Michael Simonson, Andrew Carter, Allie Dakroub and Melissa McNeil

M: So what was the general overview, why did you find it compelling?

T: So many of us are already familiar with these concepts – retrieval, interleaving and spaced repetition, all of these popularized by the 2014 book “Make it Stick” that has just been white hot in Med Ed these last few years. But the thing that really hit me about this session was that it’s sorta a lesson within a lesson – they kept using these strategies throughout their talk – and inspired me think how I can incorporate it into my own virtual teaching. The whole experience really got me excited again about what we can do to help our learners get the most bang for their buck. And it’s not always what you think.

Dr. McNeil: So I think that some of the most effective strategies are counterintuitive. Learning that feels hard is actually a lot more effective than learning that feels easy. Learning’s a lot deeper and more durable when it’s effortful. So again, these pathways going back pathways in the brain that are worn deeper and used repetitively over time are easier to follow the next time.

M: Okay, so learning that is durable takes work – which really is one of the central tenets of Make it Stick and my boy Danny Kahneman’s behavioral economics theories… And that’s counterintuitive for me as a teacher, because I spend a lot of my time trying to help my learners digest new material as easily as possible.

T: You’ve gotta trust them on this Marty, it’s worth the sweat. And these guys even took it a step further, applied it to the med student’s security blanket – notetaking – and this was the part that really hit close to home for me. Because while I was listening, I was thinking of myself as a med student… the countless hours I’ve spent passively digesting course material – the stacks of dog-eared first aid reviews collecting dust, the graveyard of burnt out highlighters – all of this trying to get crucial information from my working to long term memory. And I’ve gotta say, I’ve only gotten worse with our virtual didactics since COVID hit.  But it sounds like there’s a better way, and really, it’s back the basics. 

Dr. Dakroub: There are three key details to note about taking notes though. And the first key detail, which is definitely the most important one is that handwritten notes are definitely greater than typed notes. And this study took 67 Princeton students and ask them to watch five Ted talks with the caveat that the Ted talks were not over common knowledge things. And students were randomized to take notes by computer or to take notes by pen and pencil. So on the next slide, what you’ll see is that when they were tested over the material, the students did better who took longhand notes. But what’s interesting is that difference was really statistically pronounced when they were asked questions over conceptual understanding of the data. Meaning both students who wrote notes down and typed could recall maybe some facts about the information that they were asked, but when it came down to cognitively process and cognitively answer questions related to the complex concepts that were asked far in away, the students who took the handwritten notes had a more robust understanding and a better ability to convey their conceptual understanding of the knowledge. The second element I want to present to you, or the second detail is that non verbatim notes are better than verbatim notes, likely correlating to what we just mentioned, that when you have to sort of take out words and purse, the information real time, you’re forcing your brain to think about and cognitively engaged with that material. And the last one I want to mention to you is that notes are more powerful when combined with retrieval. When you take notes and then quiz yourself over the notes and use them as sort of a mechanism to have to recall the information that’s when they become the most useful.

M: So in summary: We should be encouraging hand-written note-taking in learners own words and then use those paraphrased notes to test yourself. Any thoughts about how this might work in a virtual learning environment? 

T: Yeah, I can see this feeling a bit tricky. Because remember this is all about applying learning theory to the virtual environment, and now we’re saying it all comes back to pen and paper? But, what I’m going to do now is really encourage whoever is on the zoom to pull out a notebook, and then try to build in a few minutes of  reflection time at the very end so that they can actually re-process those key concepts.

M: Yeah, that sounds small, but 5-10 second pauses in noon conference has shown to lead to increased knowledge retention! Really spending those precious ending minutes reflecting and processing these learning points is so crucial.  My man, you are a stable genius. 

T: I can’t claim any ownership of those ideas, but thanks Marty. But my favorite part of the whole session was this meta point about one of the quintessential “Make It Stick” concepts – interleaving, and how we’re doing it every day on rounds without even thinking about it. It absolutely blew my mind.

Dr. Klein: Everything in life and in medicine is interleaved. Rounds is an interleave exercise of learning every time you see a different patient with a different diagnosis.

Dr. McNeil: I think the, the trick for me with spacing, to be honest, when I’m I’m running rounds, is that I don’t tell you everything I know about atrial fibrillation today. Right. Maybe today we’ll talk about rate control and maybe tomorrow we’ll talk about anticoagulation. Right. And so, so it’s, it’s, I think as internists, we struggle a lot to be honest with spacing because our completeness gene gets in the way.

M: Right – this reminds me about a really nice tweetorial from the great Dr. Jennifer Spicer of the #MedEdTwag Team when she wrote about preparing for inpatient teaching.  Dr. Spicer made this exact point – space out the learning points about these broad topics that we can cover over a week, and in doings so rounds become this amazing ongoing spiraling discussion about different disease processes as you interleave education from patient to patient over the course of several days of taking care of them. 

T: Exactly.  So my take home point from this session here Marty is that there are lessons we can take from cognitive psychology to make our virtual teaching more effortful, and therefore more effective, for our learners. 

Mentoring in the Modern Era 

M: Right on. So, next episode on deck is Mentoring in the Modern Era: More than the Traditional Dyad. This talk was led by Dr. Maria Wamsly from UCSF, Dr. Bernice Ruo from UC San Diego and Dr. Subha Ramani from Bringham and Women’s Hospital.

T: Loved the coast-to-coast expertise with this session… too bad these guys have to listen to the hot takes from a couple of corn fed Midwesterners like us, huh Marty?

M: Gaahhh Tim –  I’m officially a Midwesterner now, aren’t I?

T: Search your feelings, Marty…you’ve always been a Midwesterner.

M: I really enjoyed this talk, as an early-career faculty I’m still not sure I know exactly what mentorship is supposed to look like. Right now, I see it more like another regularly scheduled zoom where I try not to disappoint someone who I deeply admire, ya know what I mean?  But I felt like I left this workshop really had a few tangible points, especially why I should consider peers and even current learners in this “mentorship network.” This is in contrast to the traditional “hope-I-don’t-let-you-down” dyad.

T: Hah. Yes, let’s avoid the inevitable disappointment when your attending crush texts you “new phone who dis” and start with our peer mentors.

Dr. Ramani: As far as a peer mentors, there is a congruence, there is a social and intellectual congruence. We are all, we have lived experiences that are similar and understand each other’s challenges.

M: There is so much truth to that.  I have a great group of colleagues at my institution and we have a group text and we sort of meet ad hoc. The group definitely has the foundation of a peer mentoring group, but I think the next step would be to add in some of the formality of a traditional mentoring relationship.

T: Oh, yeah. I can see making it a bit more formal being a tough needle to thread there.  So have you given any thought on how you’re going to do that without sacrificing the collegiality that makes it special?

M: Yeah – that’s certainly the tough part of this.  Our group has somewhat regular meetings – but they are sort of wandering conversations about whatever is going on.  What the workshop presenters suggested was a mentorship meeting structure that I found fantastic.  They called it the 5/10/30 rule, and it can really be applied to any mentorship gathering.

Dr. Lo: There’s something called five, 10 and 30 rule of meetings where you can spend your hour about five minutes, just checking in and seeing where things are at. Then secondly, talking for about 10 minutes on short-term goals, and then to spend the majority of the time, approximately 30 minutes speaking about long-term goals and how to take steps to achieve those long-term goals. And then to spend the last 15 minutes wrapping up and clarifying kind of next steps and tasks and setting up time for the next meeting.

T: The idea here is that you spend 5 minutes checking in early in the mentoring meeting. Limit discussion about short-term goals to 10 minutes and spend 30 minutes on long-term goals and steps to achieve them.

M: So I love the structure of this, and as it relates to peer mentorship group, I sort of envision applying this to our group as maybe a once per person per year will run through that 5/10/30. So one out of our 12 monthly meetings we would spend in this structure while the other 6-7 would be our more free-form yacking about politics and office gossip.  And the final point they brought up that I felt was worth sharing here is that was asking learners to serve as part of one’s mentorship network – and this would be especially important for you or whose career path is one in medical education. 

Dr. Ramani: Who best to tell us or provide us support and give us feedback than our learners?  They see us through a different perspective and best of all, they’re not trying to mold us in their image. Okay. They’re not pushing us to seek certain goals.

T: Wow I love that idea – asking learners for very deliberative and specific mentoring feedback. We spend so much time thinking about evaluation in the other direction. But they’ve seen us teach, where we’re showing the depths of our knowledge and really exposing our vulnerabilities, right? And we all ask for end-of-rotation feedback from our learners, but I’m not sure I’ve ever actually explained to the student why that type of feedback helps me, you know like where it sits in the context of my broader goals as an educator. I really like this.

M: Yeah exactly. Certainly something to consider moving forward.  So quickly summing up the high-yield pearls that I got out of this talk – mentoring can and should exist in a relationship network, not necessarily in one-on-one traditional dyad that we often see. We should purposely consider peers and juniors in these networks – and a nice framework for mentorship meetings is the 5-10-30 model.

Clinical Updates in Medical Education 

T: Yeah, the next session we wanted to highlight was the Clinical Updates in Medical Education session. This was led by Drs. Maryann Overland, Tyler Albert and Paul Cornia of Univ Washington, Dr. Megha Garg of UCSF and Dr. Mel Anderson of Colorado. 

This was a tour de literature of recent papers, and the session leaders made a priority to address anti-racism and equity research within medical education.  

But the first study that really caught my attention was a randomized trial out of JHM looking at point-of-care ultrasound learning among IM trainees. Quick note that POCUS = point-of-care UltraSound. And full disclosure Marty, I am a huge POCUS geek.

M: You are a huge POCUS geek.  And I knew you were going to talk about this paper!  But idk man, this paper wasn’t exactly flattering to the POCUS among us…

T: Fair enough. But this study is so timely. Ultrasound tech is getting sleeker, cheaper, more portable, and the day may soon come where we can all afford to bring a handheld probe on rounds with us. The question is, should we? This study looked at whether carrying around a handheld device in addition to a POCUS lecture series improved POCUS proficiency compared a control group that just got the lecture series.

Dr. Anderson: And here’s what they found.. despite having their own personal ultrasound devices, there was no difference in the frequency of conducting POCUS exams. Knowledge as assessed via the multiple choice exam also was not different between the groups, although both showed substantial gains over their internship year. However, despite not actually being more competent with POCUS residents, randomized to personal ultrasound devices reported feeling more confident to perform specific maneuvers. They were much less likely to cite a lack of confidence as a barrier to performing POCUS 17.6% and the personal ultrasound group versus 50% in the control group. I calculated a number needed to create false confidence of only three, which is not good.

T: Man, as a POCUS educator, that  “number needed to create false confidence” really hurts.

M: Yeah that is tough – sounds pretty much like a classic Dunning-Kruger effect – that lack of skill is accompanied by a lack of awareness of our limitations. This can really be a particularly dangerous combination in the clinical setting.

T: This comes up in POCUS literature all the time and I talk about it with my learners frequently – it’s not only important whether you can get high quality images, but knowing how far you can interpret the information you have.  When  you think about it, it’s pretty dangerous to NOT be aware of those limitations…

M: You doing OK buddy?  That’s a bit of a POCUS burn there.  I’d ask you if you had any vaseline to treat that wound but I’m sure you have some goop lying around… this is getting gross let’s move on.

T: Agreed, let’s keep moving. So the session organizers were really transparent that they wanted to use their platform to elevate awareness of research that shows just how prevalent and pervasive racial and gender bias is, not just in our institutions and promotion structure, but also in the very fabric of our healthcare delivery system.

M: Just as a side note, this is why SGIM is such an awesome organization. The session organizers could have run through OSCE studies and TBL papers… but really promoting equity scholarship was a deliberate choice here.  So what did they highlight in the education/advocacy overlap area.

T: The first one really stuck with me was a cross-sectional study from JAMA Network Open, which examined gender bias in clinical evaluations.

Dr. Overland: The study raises very intriguing questions about why female residents assessments, they peak and plateau, while male residents assessments continue to improve throughout all three years of residency. I think it’s highly unlikely that there’s some sort of countrywide gender-based difference in patient care quality that’s able to explain the differences in these scores. Women in traditionally male dominated fields often have to carefully balance being likable with being authoritative and female residents may be highly assessed for communal leadership styles in the R2 year when assessors are more likely to be critical of overconfidence in residents. However, as female residents grow into the R3 role and begin to display higher levels of independence, assertiveness, and autonomy, their professional roles and behaviors might not align with unconscious expectations of normative gender behaviors resulting in lower scores on assessments.

T: This really caught me off guard, because this is an area growth for me. I try to be cognizant of the role my unconscious biases have in the way I evaluate learners, but honestly this was just a blind spot for me. I hadn’t even given thought to the way that subconscious expectations about the gender roles of learners might be impacting the way I evaluate them. I just have to be better, you know? 

M: I fully appreciate that, and I think we all have room for growth here. So thank you for raising this paper. What other studies did you find compelling?

T: One more compelling study from this session I wanted to highlight, also from JAMA Network Open addresses the ubiquity of biased patient behavior that BIPoC, LGBTQ and female trainees are routinely exposed to. This ranges from explicit racial epithets, role questioning, refusal of care, and all the way up to sexual harassment.

Dr. Overland: The big takeaway here is that the annual incidents of residents experiencing bias patient behavior approaches 100%. Residents are more commonly bearing witness to this behavior than experiencing it directly. However, unsurprisingly, some groups experienced specific types of patient behavior more than others. For example, 99% of Asian residents experience being confused with other Asian team members by a patient at least once in the past year. And basically all women experienced assumptions of non-physician status. The most commonly reported incidents overall are related to race and ethnicity. 45% of our black and Latin X residents have experienced refusal of care and request to change physicians over the past year.

M: This is unbelievably unsurprising… I mean every, single time I am on service I find myself addressing microaggressions based on gender or race or sexual identity. You know, I do see this. 

T: Yeah Marty and many of the residents reported not responding to biased behavior in the moment, or bringing to administration. And you know its no surprise why. They’re concerned they won’t have support at the institutional level.  Because so many institutions have archaic, nebulous reporting and accountability structures. And trainees fear retaliation for speaking out. 

M: The big takeaway for these last coupe of papers is that as a white guy in a position of leadership/power/privilege that I need to be an active upstander instead of a passive bystander.  And in preparation for this episode you and I spoke about the need to avoid “white knighting” these situations, that’s like swooping in and feeling like I have to fix it – there’s no question that fostering safe spaces is a work in progress for me and us and studies like this really highlight the importance of these areas of growth.

Anti-Racism in Medical Education: Concrete Actions to Further Social Justice and Racial Equity

M: So this is a great place to move on to the next session that we wanted to highlight, Anti-Racism in Medical Education: Concrete Actions to Further Social Justice and Racial Equity.  

This session was presented by a really amazing group of educators on behalf of the SGIM Education Committee. They are Drs. Sarah Merriam, Rachel Bonnema, Danielle Jones, Kate Lupton, Rani Nandiwada, Aditi Puri, Laura Snydman, Carla Spagnoletti and Eloho Ufomata. 

T: Man it really must have been a heavy lift to distill down such an important topic and give it the justice that it warrants and deserves. 

M: Yeah, it really was… they crammed a lot into this hour and it really was an amazing talk. I organized my take home points into really compelling “big picture” ideas. These are things like addressing structural racism within our academic organizations and some educational policy considerations the session organizers mentioned. And then I’ll review some smaller, but immediate, put into practice tomorrow type points.

T: Okay, that sounds great.  Let’s start with the big picture stuff. What you got?

M: So big picture points: First, at my institution – like I’m sure many others – really has tried to respond to the growing awareness of structural racism. The question becomes, where to go from there:

Dr. Merriam: Existing anti-racism curriculum tend to focus more at an individual level on things like unconscious bias and cultural competency to address issues of diversity and inclusion. However, these frameworks have really been critiqued as oversimplifying culture, propagating stereotypes, and providing a very superficial understanding of the impact of race and identity, and certainly overlooking structural inequities and issues of privilege. 

M: There’s no question that most of us can look at our anti-racism curricula and think about gaps and opportunities.  And one thing that the presenters proposed was to actually create a new core competency around structural racism – perhaps titled “Mastering the Effects of Structural Racism.”

T: Right, I mean what better way to make real change happen than to hold med schools and residency programs accountable to learner progress in this area. If we created a new core competency that would really hold their feet to the fire to create more high impact education on structural racism.

M: Exactly. And props to the Internal Medicine ACGME Milestones Update from July 2021, which now include identification of personal bias as a skill within their interpersonal communication skills competency.  This is a step short of an entire new core competency, but certainly a step in the right direction. Moving on to more immediate-term action items. Honestly a learning point for me was the interaction between microaggressions, which for me, it’s been spoken about a lot, and stereotype threat, which again for me, was a new term.

Dr. Jones: Microaggressions is something that we’ve mentioned before. Microagressions can lead to stereotype threat stereotype threat refers to the risk of conf confirming negative stereotypes about an individual’s racial, ethnic, gender, or cultural group. You might say that this is the internal corollary to microaggressions.

T: So I have to be honest, a little embarrassing to admit but I hadn’t heard of stereotype threat before this talk. And it makes a ton of sense.  You know if you’re are a third year medical student I can totally see how a microaggression could make an already nerve-racking presentation even more anxiety-provoking and seem even more higher stakes because now they might feel like they can’t mess up or else prove that microaggression correct. It’s absolutely terrible. 

M: A bit later in the talk, Dr. Ufomata also connected stereotype threat with the cognitive load required to code switch. If that’s a new term for you, it’s basically when people of color essentially change the way they speak and act at work or school because they feel that being themselves can lead to discrimination.  Dr. Jones mentioned that President Barack Obama made an art form out of this survival tactic.

Dr. Jones: As you can imagine, cold switching depletes cognitive resources.. It takes a lot to change the way one might speak, behave, um, to make others feel comfortable. This can then impede performance and ultimately result in further isolation. At the same time that you’re in faculty, you’re experiencing isolation, they’re also experiencing hyper visibility, both because they stands out physically and because our institutions try to showcase folks who are URM background in marketing and recruitment materials. One of the consequences of this hyper visibility is an intensification of the stereotype threat.

T: Yeah Marty, I appreciate the learning point and it’s easier said than done. But really feel this is just a call to action for team leaders to create an environment where trainees feel safe in their own identity and don’t feel the need to code switch.

M: Couldn’t agree more my man.  Another concrete takeaway from the talk that I appreciated was around assessments.  

Dr. Nandiwada: One of the things that happens when we’re training is that so much of our grading and assessment is based on peer to peer comparison. And so this article by Teherani actually does a really fantastic job of bringing out that if we were to really focus on our individual learners, I’m coaching them on focusing on patient care on their growth, rather than the side-by-side comparison of learner to learner that inherently would reduce some of the bias.

M: I appreciated how Dr. Nandiwada was really pushing us to avoid those side-by-side comparisons of learners in favor of a holistic approach really centered on growth.

Dr. Nandiwada: Is there some kind of audit system that we built in to help make sure that it’s actually a accurate assessment? How do we scrape more of that standardization so we’re not falling back on our unconscious bias with word choice, right? And we’re really looking at competency-based evaluation.

T: Okay, so this is something that I can put into practice tomorrow.  It’s admittedly hard to avoid comparisons of learners because they often rotate with us in pairs or groups. But, if we focus our assessments on the learner’s patient care and the narrative assessment section of evaluations should combat our own inherent biases as they creep up.

M: Right, and the attending corollary to learner assessments is probably our faculty annual review.  As a fellow, you probably haven’t gotten a chance to participate in these gems – but let me tell you few things are more pleasant than spending 10+ hours reviewing a year of outlook calendars and email threads to figure out things like exactly how many residents were at that zoom talk you gave last September?

T: Ahhh – this is the Valhalla of attendinghood that I’ve been working for two decades to achieve? You know that scene in Billy Madison when Adam Sandler grabs the kid by the face and says “Stay here as long as you can?”  … But anyway. The presenters actually had a really cool idea about how our divisions might actually foster recognizing antiracism work in our annual review or faculty assessments.

Dr. Lupton: We also recommend that institutions broadly apply anti-racist indicators and benchmarks, um, and include those in annual assessment of progress for all faculty. Considerations could include identifying an objective measurement for anti-racism and equity work, as we were, as we previously discussed, or creating a narrative section on the CV that asks faculty to, um, elaborate on their own contribution to diversity.. making it an expectation that all faculty, not just URM faculty, but all faculty will reflect on their own contributions and complete the section as part of their, um, yearly review and as part of their advancement.

M: Wow, I couldn’t agree more and think that’s a perfect place to end our SGIM 2021 Meeting, Med Ed edition.

T: Noooo, I don’t want it to end. 

M:  Look out for two other episodes from Core IM reviewing content from these awesome talks. 

T: If you found this episode helpful, please share with your team and colleagues and give it a rating on Apple podcasts or whatever podcast app you use! It really does help people find us! 

M: Huge thanks to the Core IM team for audio editing and Preeyal Patel who made the accompanying graphic. Opinions expressed are our own and do not represent the opinions of any affiliated institutions. 

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