Oxentenko, Amy S.

Background: Grand rounds and named lectureships are forums in academic medicine for sharing research, scholarly achievements, and clinical expertise. An invitation to speak at grand rounds is regarded as an honor and is part of the pathway to academic promotion. We describe gender representation relative to the national academic medical workforce among invited speakers at departmental grand rounds and annual named lectures at a large academic medical center. Materials and Methods: Lists of external speakers for grand rounds from 2015 through 2017 were obtained from 18 departments and for annual named lectures from 2007 to 2017 from 7 departments. Results: Of the 783 invited speakers to the 25 speaker series, there were 178 women (22.7%). The proportion of women speakers for departmental grand rounds ranged from 0% to 59.3%; representation of women speakers was lower than representation in their specialty in 14 of the 18 departments and significantly lower in 4 of the 18 departments. In four departments, there was a higher proportion of women than available in the specialty-specific academic medicine workforce. The proportion of women who spoke at annual named lectures was significantly lower in two of seven lecture series and ranged from 0% to 21.2%. Three departments had no women speakers. Conclusions: The underrepresentation of women as speakers is a potential target to improve gender representation and role modeling and provide equitable opportunity for academic advancement. Solutions may include formal diversity and inclusion training, intentional overrepresentation of invited female speakers, and inclusion of women on grand rounds planning committees.

Abstract Background Medical education encompasses many activities (e.g., teaching, supervision, mentorship, and administration). Little research has explored what the term "medical education" means to trainees or assessed the importance postgraduate medical trainees place on education as part of their career plans. Methods We conducted a survey of fellows in all subspecialty training programs at a three-site academic institution. We asked multiple choice and Likert scale questions to characterize fellows’ perception of, interest and training in medical education. Results One hundred sixty-nine of 530 (31.9%) fellows responded. Fellows were training in subspecialties of internal medicine (49.7%) and surgery (13.0%), among others. Most fellows planned careers in academic medicine (38.5% clinician-educator, 22.5% clinician-investigator, 17.2% academic clinician). Fellows reported that their conception of medical education involved supervising trainees in a clinical capacity (93.5%), teaching in the classroom (89.3%), and providing mentorship for trainees (87.6%). Respondents identified “being an educator” as extremely (43.8%) or moderately (43.2%) important for their future careers. Only 30.2% had received formal training in medical education, but 61.5% felt that formal training should be required for those pursuing careers with strong educational components. Conclusions Most subspecialty fellows surveyed planned careers in academics and felt that medical education was important to their professional future. While less than a third received formal training in education, almost two thirds felt that such training should be required for a career as an educator. This study provides evidence for the creation and promotion of educational training programs for trainees interested in careers involving medical education.

INTRODUCTION: Endoscopy- related injury (ERI) is common in gastroenterologists. This study aimed to evaluate the prevalence of self-reported ERI, patterns of injury and knowledge of ergonomic strategies in endoscopists who are ACG physician members. METHODS: A 38-item survey was developed and initially piloted at three academic medical centers. Through the ACG Women in GI Committee and ACG Governing Board sponsorship, the survey was administered to ACG physician members. Statistical analysis was performed using SAS Enterprise Guide 7.0 (SAS Institute Inc., Cary, NC); chi-square tests and descriptive analysis evaluating associations between multiple variables and ERI. RESULTS: Of the 14759 total surveys sent, 5940 were opened, and only completed surveys were included (n = 1133). ERI was reported by 71% of the respondents including 49% of trainees. More than half of the respondents reported pain in the thumbs (64%), hand/fingers (59%), neck (57%), and lower back (54 %). The most common causes of ERI reported were torqueing with the right hand (64%), adjusting tip angulation with left hand (53%), standing for prolonged periods of time (59%), and standing in awkward positions while supporting an endoscope (58 %). While no differences were noted in characteristics associated with overall ERI, including sex ( P = 0.77), performance of interventional endoscopy or a focus in another GI domain ( P = 0.55) women were more likely to have upper extremity pain and upper back pain (see Table 2). There were statistically significant differences between genders in the mechanisms of ERI (see Table 3). Most respondents did not receive training during fellowship (68%), or discuss ergonomic strategies in their current practice (63%). Those without training in ergonomics were more likely to report ERI ( P = 0.02). 81 % of respondents noted a desire for more training in ergonomic strategies to reduce ERI. CONCLUSION: The results of this study show an overwhelming occurrence of ERI in all GI physicians and in nearly half of the trainee respondents. Preliminary analysis shows a significant difference between men and women with regards to specific areas of ERI and contributing mechanisms. Results strongly support training and a desire for continued education in ergonomic strategies as a preventative strategy. Education and prevention of ERI represent rich opportunities for improving key aspects of clinical practice, reducing burden on physicians, and decreasing interruptions to clinical care.

Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.

Purpose To begin to quantify and understand the use of the flipped classroom (FC)—a progressive, effective, curricular model—in internal medicine (IM) education in relation to residency program and program director (PD) characteristics. Method The authors conducted a survey that included the Flipped Classroom Perception Instrument (FCPI) in 2015 regarding programs’ use and PDs’ perceptions of the FC model. Results Among the 368 IM residency programs, PDs at 227 (61.7%) responded to the survey and 206 (56.0%) completed the FCPI. Regarding how often programs used the FC model, 34 of the 206 PDs (16.5%) reported “never”; 44 (21.4%) reported “very rarely”; another 44 (21.4%) reported “somewhat rarely”; 59 (28.6%) reported “sometimes”; 16 (7.8%) reported “somewhat often”; and 9 (4.4%) reported “very often.” The mean FCPI score (standard deviation [SD]) for the in-class application factor (4.11 [0.68]) was higher (i.e., more favorable) than for the preclass activity factor (3.94 [0.65]) ( P < .001). FC perceptions (mean [SD]) were higher among younger PDs (≤ 50 years, 4.12 [0.62]; > 50 years, 3.94 [0.61]; P = .04) and women compared with men (4.28 [0.56] vs. 3.91 [0.62]; P < .001). PDs with better perceptions of FCs had higher odds of using FCs (odds ratio, 4.768; P < .001). Conclusions Most IM programs use the FC model at least to some extent, and PDs prefer the interactive in-class components over the independent preclass activities. PDs who are women and younger perceived the model more favorably.

Purpose The flipped classroom (FC), in which instructional content is delivered before class with class time devoted to knowledge application, has the potential to engage residents. A Mayo Clinic Internal Medicine Residency Program study was conducted to validate an FC perception instrument (FCPI); determine whether participation improved FC perceptions; and determine associations between resident characteristics, change in quality improvement (QI) knowledge, and FC perception scores. Method All 143 internal medicine residents at Mayo Clinic, Rochester participated from 2014 to 2015; some experienced a flipped QI curriculum and others completed the traditional nonflipped course. The FCPI was developed, and factor analysis revealed an intuitive two-factor structure: preclass activity and in-class application. Residents were surveyed before and after the monthlong curriculum to measure changes in perception, and the QI Knowledge Assessment Tool was employed to measure knowledge improvement. Results Postcourse FCPI scores significantly increased for three of the eight items. QI knowledge increased significantly among residents who experienced the FC compared with residents who completed the non-FC curriculum. Those without prior FC exposure demonstrated a significant increase in QI knowledge compared with those with previous FC experience. The FCPI had compelling validity evidence with improved scores after curriculum exposure and associations with greater engagement in online modules. Conclusions Residents who participated in the FC demonstrated improved QI knowledge compared with the control group. Residents valued the in-class application sessions more than the online component. These findings have important implications for graduate medical education as residency training programs increasingly use FC models.