We Need to Talk: Advancing Open Inquiry.

ABSTRACT: In this article, the authors explore the current state of divisiveness in U.S. society and its impact on medical schools. Higher education institutions are increasingly faced with challenges in supporting freedom of speech while respecting marginalized groups who may feel attacked by certain kinds of speech. "Cancel culture" has resulted in misunderstandings, job loss, and a growing fear of expressing ideas that may offend someone. These dynamics are particularly relevant in medicine, where issues of racial justice, reproductive health, gender identity, and end-of-life care, occurring in the context of personal and religious differences, affect patient care.Despite these challenges, there must be ways to talk and listen respectfully to each other and bridge sociopolitical divides. Open inquiry and discussion are essential to medical education and patient care. There needs to be a common language and a setting where open engagement is encouraged and supported. This requires expertise and practice. The authors describe several models that offer constructive approaches toward this goal. Organizations including Braver Angels, Constructive Dialogue Institute, Essential Partners, and Greater Good Science Center are working to advance open inquiry and discussion, as are psychology leaders whose methods encourage empathy and learning from one another before engaging in a charged, polarized discussion topic. These and others are using methods that can benefit medical education in supporting diversity of ideas and deliberative discussions to equip students with skills to overcome divisiveness in their training and clinical practice.Promoting civil discourse is critical to society's well-being, and respectful engagement and open inquiry are essential to medical education and patient care. Despite the challenges posed by current societal divides, there are ways to talk with each other respectfully and constructively. The authors assert that this requires ongoing effort and practice, which are crucial for the health care enterprise to flourish.

Advancing Salary Equity in Schools of Medicine in the United States.

Equity, in broad terms, is a critical issue and has been identified as an area that needs particular attention in academic medicine. Gender equity, as a subset of overall equity, has equally been shown to be lacking in academic medicine, and most medical schools and academic health systems are involved in substantive journeys to improve all dimensions of equity, diversity, and inclusion. This Invited Commentary calls for including gender-based salary equity as a foundational accomplishment for institutions seeking to achieve overall equity. In addition, the authors provide evidence and recommendations to guide institutions toward best practices in achieving salary equity. They propose 4 areas of consideration: (1) prioritization by leadership; (2) prioritization of resources to ensure success; (3) development of corrective action plans which are "automatic" and based on clear guidelines; and (4) transparency of methodology, data, and results.

The IWill MCW Campaign: Individual Actions to Advance Gender Equity.

Advancing equity for women remains an urgent and complex problem at academic health centers. Attempts to mitigate gender gaps have ranged widely and have been both slow to occur and limited in effect. Recognizing the limitations of previously attempted solutions and fueled by the #MeToo and #TimesUp movements, the Medical College of Wisconsin (MCW) stepped outside known approaches (e.g., women's leadership plans and programming) to design and implement a strategic campaign that promotes gender equity through fostering change in systems and social norms. This campaign, IWill MCW (launched in 2019), emphasizes the power of individual responsibility for positive change. The IWill MCW campaign employs a 2-pronged approach. The first is the creation of personal call-to-action public pledges focused on 5 aspects of gender equity, along with the provision of supportive resources to reinforce positive change. The second is the use of those pledges to raise awareness of gender inequity in academic medicine by fostering meaningful dialogue meant to alter mental models of equity, relationships, and power dynamics. In the initial 6-week phase of the IWill MCW campaign, leaders reached out to all MCW faculty (2,002), staff (4,522), and learners (1,483) at multiple campuses. This outreach resulted in nearly 1,400 pledges, including 30% (n = 420) from men. The effort also engaged over 90% (n = 101) of members of MCW senior leadership teams. The feedback from the initial campaign has been positive. Lessons learned include realizing the importance of public pledges, engaging male allies, and following up. The authors suggest that the IWill MCW campaign provides a model for academic health centers to advance gender equity and shape an environment in which people of all genders can thrive.

Community and Research Perspectives on Cancer Disparities in Wisconsin.

INTRODUCTION: Significant disparities are apparent in geographic areas and among racial/ethnic minority groups in Wisconsin. Cancer disparities are complex and multifactorial and require collaborative, multilevel efforts to reduce their impact. Our objective was to understand cancer disparities and identify opportunities to collaborate across community and research sectors to address them. METHODS: From May 2017 through October 2018, we assembled groups of community members and researchers and conducted 10 listening sessions and 29 interviews with a total of 205 participants from diverse backgrounds. Listening sessions and interviews were scheduled on the basis of participant preference and consisted of a brief review of maps illustrating the breast and lung cancer burden across Wisconsin, and a semistructured set of questions regarding causes, solutions, and opportunities. Interviews followed the same structure as listening sessions, but were conducted between a facilitator and 1 or 2 individuals. Major themes were summarized from all sessions and coded. We used the Model for Analysis of Population Health and Health Disparities to identify areas for collaboration and to highlight differences in emphasis between community participants and researchers. RESULTS: Participants identified the need to address individual behavioral risks and medical mistrust and to build equitable multilevel partnerships. Communities provided insights on the impact of environment and location on cancer disparities. Researchers shared thoughts about societal poverty and policy issues, biologic responses, genetic predisposition, and the mechanistic influence of lifestyle factors on cancer incidence and mortality. CONCLUSION: Listening sessions and interviews provided insight into contributors to cancer disparities, barriers to improving outcomes, and opportunities to improve health. The unique perspectives of each group underscored the need for multisector teams to tackle the complex issue of cancer disparities.

More than a Conversation: the Power of Bringing Scientists and the Community Together to Change Perceptions About Cancer.

According to the Centers for Disease Control and Prevention, up to 40% of annual deaths are due to preventable, modifiable risk factors (Centers for Disease Control and Prevention 2014). Evidence in the literature suggests that increased knowledge and engagement is a critical step in preventing disease and improving health behaviors (Health Promotion International 15(3):259-267, 2000; Risk Manag Healthc Policy 3:61-72, 2010; Urology 61(2):308-313, 2003). Educational seminars, titled Conversations with Scientists, are offered twice per year by the Advancing a Healthier Wisconsin Endowment with the goal of helping community members, patients, and families inform themselves and others about science and health. In the first series, Cancer: Past, Present, and Future, the goals of increasing (1) knowledge, (2) intent to improve health behaviors, and (3) intent to disseminate information to friends and family were evaluated. Additionally, focus groups and interviews were conducted with speakers and audience members to explore strengths of the existing program format and opportunities to improve. The World Health Organization estimates that between 30 and 50% of all cancer cases are preventable, and has called for efforts to raise public awareness of cancer risks (World Health Organization 2017). Findings indicate that the existing seminar format achieved its intended goals, and provided additional value that can be leveraged to improve health outcomes for participants and their families.

Expanding the Health-care Pipeline through Innovation: The MCW model.

In 2016, the Association of American Medical Colleges projected a physician shortage in the United States of approximately 90,000; in the same year, the Wisconsin Hospital Association projected a shortage of 2,000 physicians in Wisconsin. The Medical College of Wisconsin has begun to address these shortages in three ways: 1) creation of immersive regional medical school campuses in Green Bay and Central Wisconsin, in partnership with rural serving health systems; 2) creation of rural-based psychiatry and family medicine residency programs in Green Bay and central Wisconsin; and 3) expansion of the scope of practice of pharmacists through creation of a new School of Pharmacy in collaboration with the Medical College of Wisconsin School of Medicine. This article will discuss those approaches, history and progress to date, principles used, and future plans to address the impending physician shortages.

Science of health care delivery as a first step to advance undergraduate medical education: A multi-institutional collaboration.

Physicians must possess knowledge and skills to address the gaps facing the US health care system. Educators advocate for reform in undergraduate medical education (UME) to align competencies with the Triple Aim. In 2014, five medical schools and one state university began collaborating on these curricular gaps. The authors report a framework for the Science of Health Care Delivery (SHCD) using six domains and highlight curricular examples from each school. They describe three challenges and strategies for success in implementing SHCD curricula. This collaboration highlights the importance of multi-institutional partnerships to accelerate innovation and adaptation of curricula.

Opening the Black Box: Conceptualizing Community Engagement From 109 Community-Academic Partnership Programs.

BACKGROUND: This research effort includes a large scale study of 109 community-academic partnership projects funded by the Healthier Wisconsin Partnership Program (HWPP), a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin (MCW) in Milwaukee, Wisconsin. The study provides an analysis unlike other studies, which have been smaller, and/or more narrowly focused in the type of community-academic partnership projects analyzed. OBJECTIVES: To extract themes and insights for the benefit of future community-academic partnerships and the field of community-engaged research (CEnR). METHODS: Content analysis of the final reports submitted by 109 community-academic partnership projects awards within the time frame of March 2005 to August 2011. RESULTS: Thirteen themes emerged from the report analysis: community involvement, health accomplishments, capacity building, sustainability, collaboration, communication, best practices, administration, relationship building, clarity, adjustment of plan, strategic planning, and time. Data supported previous studies in the importance of some themes, and provided insights regarding how these themes are impactful. CONCLUSION: The case analysis revealed new insights into the characteristics of these themes, which the authors then grouped into three categories: foundational attributes of successful community-academic partnership, potential challenges of community-academic partnerships, and outcomes of community-academic partnerships. The insights gained from these reports further supports previous research extolling the benefits of community-academic partnerships and provides valuable direction for future partners, funders and evaluators in how to deal with challenges and what they can anticipate and plan for in developing and managing community-academic partnership projects.

The Advancing a Healthier Wisconsin Endowment: How a Health Care Conversion Foundation Is Transforming a Medical School.

Health care conversion foundations, such as the Advancing a Healthier Wisconsin Endowment (the endowment) at the Medical College of Wisconsin (MCW), result from the conversion of nonprofit health organizations to for-profit corporations. Over the past several decades, nearly 200 of these foundations have been created, and they have had a substantial impact on the field of health philanthropy. The MCW was a recipient of funds resulting from Blue Cross & Blue Shield United of Wisconsin's conversion from a nonprofit to a for-profit status in 1999. Established in 2004, the endowment has invested approximately $185 million in 337 research, education, and public and community health initiatives that benefit Wisconsin residents. However, the transformative potential of the health care conversion foundation has extended well beyond the opportunities provided through the endowment's financial resources. As the endowment celebrates its 10th anniversary, the authors describe the transformative nature of the endowment, as well as significant accomplishments and lessons learned, in the following areas: shared power, community partnerships, translational research, and integration of medicine and public health. It is the authors' hope that these lessons will be valuable to other medical schools and the communities they serve, as they invest in improving the health of their communities, irrespective of the funding source.

The Merits and Challenges of Three-Year Medical School Curricula: Time for an Evidence-Based Discussion.

The debate about three-year medical school curricula has resurfaced recently, driven by rising education debt burden and a predicted physician shortage. In this Perspective, the authors call for an evidence-based discussion of the merits and challenges of three-year curricula. They examine published evidence that suggests that three-year curricula are viable, including studies on three-year curricula in (1) U.S. medical schools in the 1970s and 1980s, (2) two Canadian medical schools with more than four decades of experience with such curricula, and (3) accelerated family medicine and internal medicine programs. They also briefly describe the new three-year programs that are being implemented at eight U.S. medical schools, including their own. Finally, they offer suggestions regarding how to enhance the discussion between the proponents of and those with concerns about three-year curricula.

A Social Network Analysis of 140 Community-Academic Partnerships for Health: Examining the Healthier Wisconsin Partnership Program.

INTRODUCTION: Social Network Analysis (SNA) provides an important, underutilized approach to evaluating Community Academic Partnerships for Health (CAPHs). This study examines administrative data from 140 CAPHs funded by the Healthier Wisconsin Partnership Program (HWPP). METHODS: Funder data was normalized to maximize number of interconnections between funded projects and 318 non-redundant community partner organizations in a dual mode analysis, examining the period from 2003-2013.Two strategic planning periods, 2003-2008 vs. 2009-2014, allowed temporal comparison. RESULTS: Connectivity of the network was largely unchanged over time, with most projects and partner organizations connected to a single large component in both time periods. Inter-partner ties formed in HWPP projects were transient. Most community partners were only involved in projects during one strategic time period. Community organizations participating in both time periods were involved in significantly more projects during the first time period than partners participating in the first time period only (Cohen's d = 0.93). DISCUSSION: This approach represents a significant step toward using objective (non-survey) data for large clusters of health partnerships and has implications for translational science in community settings. Considerations for government, funders, and communities are offered. Examining partnerships within health priority areas, orphaned projects, and faculty ties to these networks are areas for future research.

A model to translate evidence-based interventions into community practice.

There is a tension between 2 alternative approaches to implementing community-based interventions. The evidence-based public health movement emphasizes the scientific basis of prevention by disseminating rigorously evaluated interventions from academic and governmental agencies to local communities. Models used by local health departments to incorporate community input into their planning, such as the community health improvement process (CHIP), emphasize community leadership in identifying health problems and developing and implementing health improvement strategies. Each approach has limitations. Modifying CHIP to formally include consideration of evidence-based interventions in both the planning and evaluation phases leads to an evidence-driven community health improvement process that can serve as a useful framework for uniting the different approaches while emphasizing community ownership, priorities, and wisdom.

Partnerships to address social determinants of health.

Social determinants and intractable health disparities among different populations rank at the top of challenges for health care leaders. Community-academic partnerships offer a unique blend of resources and skills that may mitigate the consequences of social determinants on the community's health. Nursing leaders should consider seeking partnerships from a variety of sources. Partnering with local academic organizations might be particularly helpful if the program is developed in a manner which is respectful of the community and works for common goals.

Leadership in a public housing community.

Community Health Advocate (CHA) programs train community members to assist and advocate for other members of the community regarding health and other community issues. These programs have been successful in improving the health and quality of life of communities. We developed a CHA program in a single public housing development. This program faced unique challenges since the advocates both worked and lived in the same setting. However, confronting and resolving these issues ultimately enhanced the quality of the program.

The Milwaukee General Assistance Medical Program: patient perspectives on primary care in an urban safety net.

PURPOSE: The General Assistance Medical Program (GAMP) is a managed care model that provides a network of services through community-based clinics and area hospitals. An evaluation of the program included patient focus groups to determine the effectiveness of this safety net. METHODS: Focus groups were conducted with patients at various hospital and community-based clinics. Researchers identified patterns and themes that emerged from the data. RESULTS: The focus groups had the following themes: (1) eligibility and enrollment policies, (2) patient advocacy, (3) primary care access, and (4) patient recommendations for improving GAMP. DISCUSSION: Patient feedback allowed for several improvements in the GAMP system, including an overview seminar and health education materials for new enrollees. Future research could include studying similar safety nets and public insurance programs to compare to GAMP. GAMP still faces many challenges as the "safety net" providing care to these populations in Milwaukee.

Overcoming barriers to effective community-based participatory research in US medical schools.

Research to improve the health of communities benefits from the involvement of community members. Accordingly, major federal and foundation funding agencies are soliciting health promotion/disease prevention programme proposals that require active community participation. However, creating such partnerships is difficult. Communities often perceive conventional research as paternalistic, irrelevant to their needs, manipulative, secretive and invasive of privacy. Many institutions and researchers view community knowledge as lacking in value. Community-based participatory research (CBPR) is a collaborative partnership approach to research that equitably involves community members, organizational representatives and researchers in all aspects of the research process. In this article the authors consider the barriers to institutional change and faculty participation in CBPR, and propose some steps for overcoming the barriers and making CBPR an integral part of a medical institution's research agenda. Training and supporting faculty in the philosophy and methods of this approach is the cornerstone of improved community-based research.

Patient empowerment strategies for a safety net.

The Milwaukee County General Assistance Medical Program implemented strategies to improve the delivery of care to its patients that include patient education and a Nurse Telephone Line. The partnership between a county-funded program and an academic health center has been very productive and resulted in improvements to the program that benefit underserved patients. The outcomes of these educational strategies are described.