Advancing Equity: Understanding, Addressing, and Mitigating Bias in Assessment in Medical Education.

Despite the growing presence of women and historically underrepresented groups in academic medicine, significant disparities remain. This article examines a key aspect of these disparities: biases in assessment and learning environments. Reviewing current literature, including in OBGYN, reveals persistent gender and racial biases in subjective clinical narrative assessments. The paper then outlines a 2-pronged approach for change: first, enhancing the learning environment, and subsequently, providing targeted recommendations for individuals, academic leaders, and healthcare institutions to effectively address these biases.

Gender Disparity in Teaching Evaluations of Pediatric Faculty by Residents.

OBJECTIVES: Despite their overrepresentation, female physicians continue to have lower rates of promotion compared with male physicians. Teaching evaluations play a role in physician advancement. Few studies have investigated gender disparity in resident evaluations of pediatric faculty. We hypothesized that gender disparities in resident evaluations of faculty exist and vary across subspecialties and primary work environments. METHODS: Pediatric faculty institution-specific evaluations completed by residents from January 1, 2015, to March 9, 2020, were obtained from a single academic center. Mean ratings of faculty performance were compared by gender using a Wilcoxon 2-sample test. RESULTS: Fifteen-thousand one-hundred and forty-two evaluations (5091 of male faculty and 10 051 of female faculty) were included. Female faculty were rated higher in overall teaching ability (female = 4.67 versus male = 4.65; P = .004). There was no statistical difference in the mean ratings of male and female faculty in the inpatient setting, whereas outpatient female faculty were rated higher in overall teaching ability (female = 4.79 versus male = 4.73; P = .005). For general pediatric faculty, females received higher ratings for overall teaching ability (female = 4.75 versus male = 4.70; P < .001). By contrast, there was no difference in ratings of subspecialty pediatric faculty. CONCLUSIONS: Pediatric female faculty were statistically rated higher than male faculty in overall teaching ability, although these findings may not be educationally significant. The difference was driven by evaluations in the outpatient setting and for general pediatricians. This study is one of the first in pediatrics adding to the continued investigation of gender disparities in academic medicine.

Controlling Hypertension through Education and Coaching in Kidney Disease (CHECK-D): protocol of a cluster randomised controlled trial.

INTRODUCTION: Chronic kidney disease (CKD) affects 30 million Americans. Early management focused on blood pressure (BP) control decreases cardiovascular morbidity and mortality. Less than 40% of patients with CKD achieve recommended BP targets due to many barriers. These barriers include a lack of understanding of the implications of their diagnosis and how to optimise their health.This cluster randomised control trial hypothesises that the combination of early primary care CKD education, and motivational interviewing (MI)-based health coach support, will improve patient behaviours aligned with BP control by increasing patient knowledge, self-efficacy and motivation. The results will aid in sustainable interventions for future patient-centric education and coaching support to improve quality and outcomes in patients with CKD stages 3-5. Outcomes in patients with CKD stages 3-5 receiving the intervention will be compared with similar patients within a control group. Continuous quality improvement (CQI) and systems methodologies will be used to optimise resource neutrality and leverage existing technology to support implementation and future dissemination. The innovative approach of this research focuses on the importance of a multidisciplinary team, including off-site patient coaching, that can intervene early in the CKD care continuum by supporting patients with education and coaching. METHODS AND ANALYSIS: We will test impact of BP control when clinician-delivered education is followed by 12 months of MI-based health coaching. We will compare outcomes in 350 patients with CKD stages 3-5 between intervention and control groups in primary care. CQI and systems methodologies will optimise education and coaching for future implementation and dissemination. ETHICS AND DISSEMINATION: This study was approved by the University of Michigan Institutional Review Boards (IRBMED) HUM00136011, HUM00150672 and SITE00000092 and the results of the study will be published on ClinicalTrials.gov, in peer-reviewed journals, as well as conference abstracts, posters and presentations. TRIAL REGISTRATION NUMBER: NCT04087798.

Gendered Expectations: the Impact of Gender, Evaluation Language, and Clinical Setting on Resident Trainee Assessment of Faculty Performance.

BACKGROUND: Gender inequity is pervasive in academic medicine. Factors contributing to these gender disparities must be examined. A significant body of literature indicates men and women are assessed differently in teaching evaluations. However, limited data exist on how faculty gender affects resident evaluation of faculty performance based on the skill being assessed or the clinical practice settings in which the trainee-faculty interaction occurs. OBJECTIVE: Evaluate for gender-based differences in the assessment of general internal medicine (GIM) faculty physicians by trainees in inpatient and outpatient settings. DESIGN: Retrospective cohort study SUBJECTS: Inpatient and outpatient GIM faculty physicians in an Internal Medicine residency training program from July 1, 2015, to December 31, 2018. MAIN MEASURES: Faculty scores on trainee teaching evaluations including overall teaching ability and Accreditation Council for Graduate Medical Education (ACGME) competencies (medical knowledge [MK], patient care [PC], professionalism [PROF], interpersonal and communication skills [ICS], practice-based learning and improvement [PBLI], and systems-based practice [SBP]) based on the institutional faculty assessment form. KEY RESULTS: In total, 3581 evaluations by 445 trainees (55.1% men, 44.9% women) assessing 161 GIM faculty physicians (50.3% men, 49.7% women) were included. Male faculty were rated higher in overall teaching ability (male=4.69 vs. female=4.63, p=0.003) and in four of the six ACGME competencies (MK, PROF, PBLI, and SBP) based on our institutional evaluation form. In the inpatient setting, male faculty were rated more favorably for overall teaching (male = 4.70, female = 4.53, p=<0.001) and across all ACGME competencies. The only observed gender difference in the outpatient setting favored female faculty in PC (male = 4.65, female = 4.71, p=0.01). CONCLUSIONS: Male and female GIM faculty performance was assessed differently by trainees. Gender-based differences were impacted by the setting of evaluation, with the greatest difference by gender noted in the inpatient setting.

When perception is reality: Resident perception of faculty gender parity in a university-based internal medicine residency program.

INTRODUCTION: Although women have entered medical school and internal medicine residency programs in significant numbers for decades, women faculty remain underrepresented in senior and departmental leadership roles. How residents perceive this gender disparity is unknown. We sought to assess resident perception of gender parity among departmental leadership and teaching faculty in our internal medicine department, and to determine the actual gender distribution of those faculty roles. METHODS: An anonymous cross-sectional survey was distributed to evaluate resident perception of gender representation of various faculty roles. Using conference schedules, resident evaluations, and our department website, we determined the actual representation of women faculty in department leadership roles, and in clinical and educational activities. RESULTS: 88 of 164 residents (54%) responded. Women residents were less likely than men to perceive that women faculty were equally represented in department leadership (45% men agreed vs. 13% women, p < 0.05), clinical teaching roles (55% men agreed vs. 28% women, p < 0.05), or facilitating educational conferences (45% men agreed vs. 28% women, p = 0.074). In 2017, the internal medicine department at our institution comprised 815 faculty members, 473 men (58%) and 342 women (42%). At that time, women faculty held 5% of senior departmental leadership positions and 21% of educational leadership positions. During the year preceding survey distribution, women faculty attended on internal medicine inpatient wards for 33% of the total number of weeks, staffed 20% of morning reports, and facilitated 28% of noon conferences. DISCUSSION: Women residents in our internal medicine training program perceived a gender disparity among faculty in leadership and educational positions to a greater extent than male residents. The perception of women trainees was accurate. In addition to disproportionate underrepresentation in leadership positions, women faculty were underrepresented in prominent educational positions, including attending on inpatient services and serving as discussants at educational conferences.

"I didn't know cognitive therapy was deep": a case study of sudden and lasting gains in cognitive-supportive therapy of depression.

"Sudden gains" is a robust phenomenon that has been found to occur among a variety of psychotherapies, clinical conditions, settings, patient populations, and differing levels of therapist expertise. Sudden gains predict superior end-of-treatment outcomes and long-term maintenance of gains. While cognitive changes during the critical session appear to account for the sudden gains, the nature of these changes has not been fully explained, and no detailed reports of how therapists and patients explain these changes have been presented. This case involved a 61-year-old woman with depression, fibromyalgia, and severe osteoarthritis who, after being in psychotherapy treatment for nearly a year, achieved sudden gains after one particular psychotherapy session. The authors discuss the nature of the cognitive changes that both the patient and therapist understood to occur during that critical session and that they believed contributed to the remission of major depressive disorder over a 2-year period. This case study also explores the possible synergistic effects of medications and cognitive interventions on sudden gains. The commentary on the case links this discussion of sudden gains to an intervention created by Viederman and Perry in the 1980s called the psychodynamic life narrative, which they found could sometimes alleviate symptoms rapidly and dramatically by reframing a person's self-image during a depressive crisis, especially one related to a feeling of despair triggered by medical illness. An increased understanding of the nature of interventions that produce cognitive changes leading to immediate, dramatic, and lasting improvement could potentially contribute to the development of more effective treatments for depression and other clinical conditions.