A framework to promote equity in clinical clerkships

Lai, Cindy J.; Jackson, Andrea V.; Wheeler, Margaret; Dhaliwal, Gurpreet; Ziv, Tal Ann; Kryzhanovskaya, Irina

doi:10.1111/tct.13050

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…For example, students are expected-and are expecting-to become skilled in health advocacy by contributing their expertise and influence to improve the health of different patient populations [20]. This competency includes recognizing health inequities, understanding the needs of communities, speaking on behalf of others when required, and supporting the mobilization of resources to effect change [21].…”

Section: The Educational Excellence Students and Society Needmentioning

confidence: 99%

Excellence in medical training: developing talent—not sorting it

Dhaliwal

Hauer

2021

Perspect Med Educ

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Many medical schools have reconsidered or eliminated clerkship grades and honor society memberships. National testing organizations announced plans to eliminate numerical scoring for the United States Medical Licensing Examination Step 1 in favor of pass/fail results. These changes have led some faculty to wonder: “How will we recognize and reward excellence?” Excellence in undergraduate medical education has long been defined by high grades, top test scores, honor society memberships, and publication records. However, this model of learner excellence is misaligned with how students learn or what society values. This accolade-driven view of excellence is perpetuated by assessments that are based on gestalt impressions influenced by similarity between evaluators and students, and assessments that are often restricted to a limited number of traditional skill domains. To achieve a new model of learner excellence that values the trainee’s achievement, growth, and responsiveness to feedback across multiple domains, we must envision a new model of teacher excellence. Such teachers would have a growth mindset toward assessing competencies and learning new competencies. Actualizing true learner excellence will require teachers to change from evaluators who conduct assessments of learning to coaches who do assessment for learning. Schools will also need to establish policies and structures that foster a culture that supports this change. In this new paradigm, a teacher’s core duty is to develop talent rather than sort it.

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Section: The Educational Excellence Students and Society Needmentioning

confidence: 99%

Excellence in medical training: developing talent—not sorting it

Dhaliwal

Hauer

2021

Perspect Med Educ

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“…In our earlier work, we describe the change process that prompted the advocacy assessment pilot. 11 The medicine clerkship was studied given the clerkship leadership’s interest in piloting this assessment and the potential to inform incorporation by other clerkships in the future.…”

Section: Methodsmentioning

confidence: 99%

Patient Advocacy Assessment in the Medicine Clerkship: A Qualitative Study of Definition, Context, and Impact

et al. 2022

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Background Advocacy is a core value of the medical profession. However, patient advocacy (advocacy) is not uniformly assessed and there are no studies of the behaviors clinical supervisors consider when assessing advocacy. Objective To explore how medical students and supervisors characterize advocacy during an internal medicine clerkship, how assessment of advocacy impacted students and supervisors, and elements that support effective implementation of advocacy assessment. Design A constructivist qualitative paradigm was used to understand advocacy assessment from the perspectives of students and supervisors. Participants Medical students who completed the internal medicine clerkship at UCSF during the 2018 and 2019 academic years and supervisors who evaluated students during this period. Approach Supervisor comments from an advocacy assessment item in the medicine clerkship and transcripts of focus groups were used to explore which behaviors students and supervisors deem to be advocacy. Separate focus groups with both students and supervisors examined the impact that advocacy assessment had on students’ and supervisors’ perceptions of advocacy and what additional context was necessary to effectively implement advocacy assessment. Key Results Students and supervisors define advocacy as identifying and addressing social determinants of health, recognizing and addressing patient wishes and concerns, navigating the health care system, conducting appropriate evaluation and treatment, and creating exceptional therapeutic alliances. Effective implementation of advocacy assessment requires the creation of non-hierarchical team environments, supervisor role modeling, and pairing assessment with teaching of advocacy skills. Inclusion of advocacy assessment reflects and dictates institutional priorities, shapes professional identity formation, and enhances advocacy skill development for students and their supervisors. Conclusions Students and supervisors consider advocacy to be a variety of behaviors beyond identifying and addressing social determinants of health. Effectively implementing advocacy assessment shapes students’ professional identity formation, underscoring the critical importance of formally focusing on this competency in the health professions education.

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“…National organizations can establish priorities, share knowledge, and reinforce accountability. [79][80][81] New approaches grounded in equity must be implemented and evaluated within every domain of medical education, including admissions, 31,82-84 curricula, [85][86][87][88] assessment strategies, 89 the learning environment, 90,91 and institutional culture. 78,92 Although some of these changes will be visible and publicly celebrated, 93 small innovations are just as important.…”

Section: Actmentioning

confidence: 99%

Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education

2021

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Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners’ experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework’s 4 steps—see, name, understand, and act—to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.

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A framework to promote equity in clinical clerkships

Cited by 9 publications

References 10 publications

Excellence in medical training: developing talent—not sorting it

Excellence in medical training: developing talent—not sorting it

Patient Advocacy Assessment in the Medicine Clerkship: A Qualitative Study of Definition, Context, and Impact

Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education

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