"Time-In": A Tool for Interrupting Bias in Medical School Admissions Committee Meetings.

PROBLEM: During high-stakes committee meetings, bias is often expressed but goes uninterrupted because there is no formal structure to interrupt it. Bias impacts decision making and can further disadvantage those from backgrounds that have been marginalized. APPROACH: The MD and MD-PhD admissions committees at the Icahn School of Medicine at Mount Sinai in NY in the 2020-2021 admissions season introduced a "Time-In" tool to interrupt bias during committee meetings. This study aimed to evaluate the impact of implementing the "Time-In" tool on committee members' perception of bias as a problem and the likelihood of committee members recognizing, reporting, discussing, and educating others about bias after implementation. OUTCOMES: There were 117 responses to the pre- and postseason surveys. In aggregate, respondents reported a statistically significant reduction in the perception of bias in the admissions process from preseason to postseason. There was no change in the likelihood of committee members in aggregate endorsing comfort in recognizing, reporting, discussing, and educating about bias; however, notable gaps existed in the comfort of groups discussing bias publicly, i.e., respondents who are from backgrounds underrepresented in science and medicine, students, and new committee members were less comfortable than their comparators. By the postseason survey, these gaps were closed. NEXT STEPS: Implementing a "time-in" allows for interruption of bias, with an impact of reducing the perception of bias, empowering individuals, and reducing gaps among groups to discuss bias publicly. A "time-in" can profoundly impact decision-making bodies that are critical gatekeepers to the composition of the physician workforce. Future directions will focus on enhancing committee members' skills in educating others about bias.

Addressing COVID-19 Vaccine Hesitancy: The Role of Medical Students.

We conducted a survey study at the Icahn School of Medicine at Mount Sinai to assess COVID-19 vaccine attitudes and behaviors among medical students. Almost all respondents (96.5%, n = 222) believed vaccines were effective and reported being asked about the COVID-19 vaccine by family members (79.0%, n = 180). However, when asked how they respond when someone shares misinformation, 89.0% (n = 202) responded they agree to avoid conflict, 44.9% (n = 102) listened empathically, and 9.3% (n = 21) corrected the misinformation. Medical school education can address this disconnect, using standardized patients and role-playing to give students the tools to address vaccine hesitancy within their communities. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01670-2.

All We Can Be: Innovations to Improve the Pipeline of Military Veterans in Medical Schools.

ISSUE: Medical schools are increasingly identifying military veteran applicants as a source of diversity, resiliency, and commitment-often derived from their personal experiences in the military. Yet, veterans remain significantly under-represented in entering classes; moreover, those veterans who do matriculate are not yet fully reflective of the diversity that the Armed Forces have to offer. Fortunately, specific measures have been shown to be effective at increasing both the number and diversity of student veterans in medical school. EVIDENCE: In 2019, there were less than 60 military veterans who entered the 144 civilian medical schools in the United States, according to the Association of American Medical Colleges. We identify common barriers faced by military veterans and propose best practices for medical schools to recruit and sustain them. We draw on the existing medical education literature about veteran support systems, and we underscore the unique challenges of veterans in medicine. Finally, we highlight innovative programs currently in place at several US medical schools that seek to address the needs of student veterans. This article provides a guide for how to recruit, assess, and nurture student veterans, suggesting a new way of thinking about this population of nontraditional medical students. IMPLICATIONS: This dearth of servicemembers significantly below what would be expected based on national demographic data is indicative of how medical schools offer few pathways to entry for military servicemembers-and far fewer for enlisted personnel and other populations traditionally under-represented in medicine. Should schools aim to recruit a veteran population that is truly representative of the military, additional measures need to be taken into consideration during the admissions review process.

Social Determinants, Risk Factors, and Needs: A New Paradigm for Medical Education.

COVID-19 and the escalation of racism and bias that has come in its wake have had a devastating impact on health professions students. In addition to academic challenges and personal health risks, aspects of students' lives that have often gone unnoticed or inadequately addressed have come to light. Financial constraints that impact access to housing and food, neighborhood safety in light of the spike in hate crimes, and the bias inherent in the continuum from premedical education to undergraduate and graduate medical education are some examples. The authors believe that to better understand students' lived experiences and determine how to best support them, the social determinants of health framework should be applied. This framework, the social determinants of education, encompasses concepts such as social risk factors and social needs in an effort to focus more intentionally on what can be done at a policy, institutional, and individual level. In response to the pandemic, the authors expanded their appreciation of students' risk factors and needs by advancing the scope and refining the definitions of 3 key determinants: from well-being to the power of individual and communal resilience, from equity to centering racial justice, and from student health to public health and infection prevention. The authors propose applying this same paradigm to the lived experiences of staff in medical education, whose needs are often neglected in favor of students and faculty, and who, in many cases, were the most negatively impacted by COVID-19 of all the constituents in an academic health center.

Key Insights From the Development and Implementation of a Novel Virtual Interview Process for Medical School Admissions During the COVID-19 Pandemic.

PROBLEM: During the COVID-19 pandemic, medical schools have offered a virtual application process. Minimal literature is available to guide best practices. APPROACH: The Icahn School of Medicine at Mount Sinai (ISMMS) implemented a completely virtual interview (VI) process in April/May 2020. Large-group sessions for applicants, interviews with applicants, and ISMMS Admissions Committee meetings occurred via Zoom (Zoom Video Communications, Inc., San Jose, California). Large-group sessions and committee meetings occurred via communal conference calls, while one-on-one, semistructured interviews occurred in individual breakout rooms. ISMMS offered live, virtual question-and-answer sessions with students and faculty, plus digital resources describing program features. After the interview day, applicants and interviewers were invited to complete anonymous surveys regarding their experiences with and perspectives of VI. OUTCOMES: Of 125 applicants and 20 interviewers, 99 (79%) and 18 (90%), respectively, completed at least part of the survey. Of the applicants, 85/95 (89%) agreed VI met or exceeded expectations, with many praising the day's organization and convenience, and 71/95 (75%) agreed they received a sufficient sense of the student body. A minority (n = 39/95 [41%]) felt limited in their ability to learn about the institution (commonly related to their inability to tour campus), and a majority (n =74/91 [81%]) would have preferred an in-person interview. Most interviewers felt comfortable assessing applicants' verbal communication skills (n = 13/16 [81%]), and most (n = 12/17 [71%]) felt VI should be an option for future applicants. NEXT STEPS: VI, likely to be a temporary-but-universal fixture of upcoming application cycles, may benefit applicants and interviewers alike by saving resources and diversifying those involved. Next steps are developing programming that will permit applicants to virtually explore the institution and connect more with current students. Future research should evaluate potential bias in VI to ensure an equitable application process for all.

Guiding principles for undergraduate medical education in the time of the COVID-19 pandemic.

As the early epicenter of the COVID-19 pandemic, New York City's medical schools experienced dramatic disruptions in every aspect of medical education. Remote learning was created, seemingly overnight, clerkships were disrupted, licensing examinations were cancelled, teaching faculty were redeployed, student volunteers rallied, and everyone was required to shelter at home. Seismic changes were required to adapt the authors' educational programs to a constantly evolving, unpredictable, and ever-worsening public health crisis. Entirely new communication strategies were adopted and thousands of decisions had to be made, often with little time to carefully reflect on the consequences of those decisions. What allowed each school to navigate these treacherous waters was a set of guiding principles that were used to ground each conversation, and inform every decision. While the language varied somewhat between schools, the core principles were universal and framed a way forward at a time when information, data, precedent, and best practices did not exist. The authors share these guiding principles in the hope that colleagues at other medical schools will find them to be a useful framework as we all continue to cope with the impact of COVID-19 on the future of medical education.

Longitudinal assessment of medical student attitudes toward older people.

Delivering adequate care to older people requires an increasing number of physicians competent in the treatment of this expanding subpopulation. Attitudes toward older adults are important as predictors of the quality of care of older people and of medical trainee likelihood to enter the geriatrics field. This study assessed the attitudes of 404 US medical students (MS) from the start of medical school to graduation using the University of California, Los Angeles (UCLA) Geriatrics Attitude Scale. It is the first study to utilize a longitudinal design to assess attitudes among students in a medical school with a longitudinal geriatrics clinical experience in the first two years and a required geriatrics clerkship in the third year. Participants' attitude scores toward older people were found to significantly decrease from 3.9 during the first two years to 3.7 during the final two. Significant differences existed between MS1 and MS3, MS1 and MS4, MS2 and MS3, and MS2 and MS4. Women and older students held significantly more positive attitudes than men and younger students. These results show that planned clinical exposures to older adults may not be sufficient to halt the decline in attitudes in medical school. A comprehensive empathy-building intervention embedded in the curriculum may better prevent this decline.

Easing the transition: medical students' perceptions of critical skills required for the clerkships.

OBJECTIVES: The preclinical years of undergraduate medical education provide educational content in a structured learning environment whereas clerkships provide clinical training in a more experiential manner. Although early clinical skills training is emphasized in many medical schools, students still feel unprepared and anxious about starting their clerkships. This study identifies the skills medical students perceive as essential and those skill areas students are most anxious about prior to starting clerkship rotations. METHODS: Open-ended questionnaires were administered to two cohorts of students, preclinical students (PCS) completing their second year and clinical students (CS) in the ninth month of the clinical training of their third year at a single urban US medical school. The following questions were addressed in the survey: which three clinical skills do they perceive are most essential for the clerkships; which skills are students most anxious about as they enter clerkships; and what additional skills training should be provided to students to ease the transition into clerkships. RESULTS: Response rate to the questionnaire was 84%. PCS (n=93) reported the three most essential skills to be prepared for clerkships are: history taking/physical examination (73%), proficiency in oral case presentations (56%), and generation of differential diagnosis (46%). CS (n=105) reported interpersonal skills (80%), history taking/physical examination (37%), and time management (26%) as most essential. PCS were most anxious about their oral case presentation skills (30%), but CS were most concerned about time management and self care (40%). CONCLUSIONS: This study identified the skills that students at one school regard as most important to have mastered before beginning clerkship training and the areas students find most anxiety provoking before and after they make the transition into clerkships. These results can inform medical educators about needed curriculum to facilitate this transition and decrease the anxiety of students entering the clinical realm.

Symptom assessment of patients with advanced cancer and AIDS and their family caregivers: the results of a quality-of-life pilot study.

This longitudinal pilot study examined differences in demographic characteristics of 101 patients with advanced illness (cancer, AIDS) and 81 Family caregivers, evaluated the reliability of the Memorial Symptom Assessment Scale for these patients and their family caregivers; obtained preliminary data regarding similarities or differences in the symptom experience oF these patients and their family caregivers and changes in symptoms over time; and identified demographic variables that may be potential covariates related to the symptom experience. All demographic variables were significantly different for patients with advanced cancer and AIDS, and their symptom experience is similar only with regard to psychologic symptoms; however, based on the Memorial Symptom Assessment Scale, cancer and AIDS patients and their family caregivers have similar symptom experiences, indicating the need for palliative care for both patients and family. Further research is needed to establish the reliability of the Memorial Symptom Assessment Scale for use with family caregivers.

Quality of life of patients with advanced cancer and acquired immune deficiency syndrome and their family caregivers.

BACKGROUND: Although definitions of palliative care include quality of life as a central concern, little research has been published about both the quality of life of patients with advanced illness and their family members, and particularly the changes in their quality of life over time. OBJECTIVES: The aims of this prospective longitudinal pilot study were to: (1) establish the reliability of multidimensional quality of life instruments based on patients with acquired immune deficiency syndrome (AIDS) and patients with cancer and caregivers; (2) identify differences in quality of life between patients with advanced AIDS and cancer, and their family caregivers with consideration of mortality, attrition, and compliance rates; and (3) examine differences in demographic variables and their potential confounding effect when measuring quality of life. METHODS: The sample included 101 patients with advanced illness (63 patients with advanced AIDS and 38 with advanced cancer) and 81 family caregivers (43 caregivers for patients with AIDS and 38 caregivers for patients with cancer). Data collection involved the monthly completion of the McGill Quality of Life Questionnaire (MQOL) for patients, and the Quality of Life Scale (QLS) for family caregivers. RESULTS: Reliability of the MQOL and QLS were established for patients with AIDS and patients with cancer and caregivers. Based on the MQOL, patients with advanced AIDS reported a lower total quality of life, and lower psychological quality of life, and a higher physical quality of life compared to patients with advanced cancer. There were no significant differences between patient groups on the one-item physical well-being subscale, or the existential well-being, and support subscales. Based on the QLS, AIDS caregivers reported greater overall quality of life, greater psychological well-being, and greater spiritual well-be- ing than cancer caregivers. There were no significant differences between AIDS and cancer caregivers with respect to physical or social well-being. From baseline entry into the study to third month of participation, there were no significant changes in total quality of life scores for patient or caregiver groups, although trends indicated a moderately high total quality of life over time for all patient and caregiver groups. Fourteen of 63 (22%) patients with AIDS patients died, while 19 of 38 (50%) patients with advanced cancer died after enrollment. Forty-six of 63 (73%) patients with advanced AIDS withdrew for various reasons other than death at some point during the 12 month time frame of the study, while 15 of 38 (39%) patients with advanced cancer withdrew. There were significant differences on all demographic variables for patients with advanced cancer and AIDS. Only religious affiliation was significantly related to quality of life for patients with AIDS, while gender was the only variable associated with quality of life for patients with cancer. There were significant differences on all demographic variables between caregivers with the exception of gender and living arrangements. Only the relationship between patients and caregivers and marital status were significantly associated with quality of life for cancer caregivers. CONCLUSIONS: In palliative care research, the challenge is to design studies that will capture changes in the domains of quality of life over time, yet will minimize participant burden and subsequent attrition rates. By measuring quality of life as an outcome variable in palliative care, health professionals can identify changes in the domains of quality of life over time for various patient populations and their family caregivers, and respond with appropriate interventions, which promote or maintain their quality of life even as death approaches.

Spiritual well-being as a dimension of quality of life for patients with advanced cancer and AIDS and their family caregivers: results of a longitudinal study.

Based on a longitudinal, quality-of-life study, this article presents pilot data regarding the spiritual well-being of patients with advanced cancer or AIDS and their family caregivers. Data include similarities and differences between the patient and caregiver populations and patient/family caregiver dyads as well as trends with regard to changes in spiritual well-being during the illness and dying process. The reliability of the Spiritual Well-Being Scale was examined for patient and caregiver groups, as was the relationship between selected demographic variables and spiritual well-being. Implications for practice are discussed.

Recruitment and retention in a longitudinal palliative care study.

A longitudinal feasibility study regarding quality of life and interventions for patients with advanced cancer or AIDS and their family caregivers was conducted to determine issues related to their recruitment and retention and to obtain pilot data relevant to the development of a larger study. At the completion of the study, a focus group consisting of the members of the palliative care research team was convened to identify barriers to and facilitators of the research process based on their research experience. The purpose of this article is to (1) describe recruitment, mortality rates, attrition rates, and compliance with data collection of patients and family caregivers experiencing an advanced illness and to (2) examine the researchers' perspectives regarding barriers to and facilitators of the research process that relate to patients and family caregivers, institutions, the data collection process, and their personal experiences. Implications for palliative care research are discussed.