Join us at 12:00 PM EST Thursday, January 9, 16, 23, 30, and February 6, 2025 for the IAMSE Winter 2025 Webcast Audio Seminar Series titled “Tailored Education: Helping Every Student Across the Finish Line.”

Tailored Education: Helping Every Student Across the Finish Line
In today’s rapidly evolving medical education landscape, one size does not fit all. This five-session series explores how personalized and precision-focused approaches can empower every medical student to succeed. Join leading medical educators in discussing strategies that support the success of every learner, from individual mentorship to data-driven learning support.

Sessions will cover the concept of precision medical education, from big-picture theories to innovative implementation, showing how adaptive learning environments can better meet diverse student needs. The series also emphasizes the critical role of mentorship, coaching, and sponsorship in guiding students towards personal and professional success. Additionally, it highlights pre-matriculation programs as a key strategy for preparing incoming students, enhancing their readiness, confidence, and ability to succeed. 

Join us as we explore innovative strategies to personalize medical education, build supportive learning environments, and guide every student towards becoming the best medical practitioner they can be.

Further details about the Winter 2025 series, including registration, speakers, topics, and more will be coming soon, so keep an eye on your inbox. For more details on our archives of previous seasons, please visit www.iamse.org.

Laying the Groundwork: Enhancing Medical Student Preparedness Through Pre-Matriculation
and Mentoring
Presenters: Dyron Corley, Ed, and Stephanie Dearden, MA, Rowan-Virtua School of Osteopathic Medicine

[The following blog was generated by Doug McKell and Akshata Naik]

The final session of the IAMSE Fall 2024 webcast focused on enhancing medical student preparedness through pre-matriculation and mentoring programs. Dr. Dyron Corley and Ms. Stephanie Dearden from Rowan Virtua School of Osteopathic Medicine discussed their three- week, free, in-person program for incoming students, which includes two curricular tracks: a) Synergistic Group Learning (SGL), which is lecture-based, and b) Problem-Based Learning (PBL), which is small group based. The program, funded by the medical school and federal work-study grants, is designed to facilitate incoming medical students’ academic, social, and environmental adjustment, introduce them to the medical school curriculum, and begin the development of their metacognitive skills. The program’s effectiveness is evaluated using the LASSI inventory and final exam scores, demonstrating first-year medical students’ improvement in anxiety reduction (stress) and learning how to apply effective study skills.

Dr. Corley described their three-week pre-matriculation program, which takes place in June before formal orientation at the start of the student’s first year. Usually, around 130 students attend this program, about 50% of the first-year entering class. He stressed that the program is built on a peer-to-peer model, fostering a strong sense of community and support. While some SOM faculty lecture about content-specific medical school topics, the pre-matriculation program primarily relies on well-qualified second year medical students to be content teachers and peer mentors. He emphasized that they wanted to establish interpersonal connections among the first-year medical students, based on the mentoring relationships demonstrated by their second-year medical students, and build relationships with the faculty and staff through large and small group interactions. He stressed that this support does not end upon completing the pre-matriculation program. The Office of Student Services continues to provide targeted interventions to those who are academically at risk and are identified as needing additional
continual support. To address this, they created the “learning groups initiative,” which allows them to follow the students needing support for the subsequent three blocks of the medical school career.

The pre-matriculation program relies on the leadership of previously successful first-year students as the driving force for its success through the abovementioned objectives and interventions. Established twenty years ago, this program was created to help students with their biochemistry preparation component because, at that time, this topic was not part of the MCAT, and the faculty needed to make sure that students were prepared for that content coming into medical school.

Dr. Corley stated that their pre-matriculation program has evolved into providing students a jumpstart in medical school and preparing them for the rigors of what they’ll experience in their first year. Their two-art core question is – What do we want our students to participate in to prepare them, and what do we want them to take away? He described the following Program Goals: The Pre-Matriculation Program will: 1. Facilitate the academic, social, and environmental adjustment of incoming first-year medical students. 2. Cultivate a safe and nurturing environment for incoming first-year medical students. 3. Establish inter-class connections and build relationships with faculty and staff. 4. Support retention efforts by providing targeted interventions to academically at-risk learners. Program Objectives after participating in the Pre- Matriculation program were that students should be able to: 1. Feel a sense of membership and belonging through supportive personal connections. 2. Demonstrate various study and metacognitive skills to become independent learners and navigate the necessary personal and environmental adjustments to medical school. 3. Engage in self-reflection and problem-solving to identify knowledge gaps and address continuing academic concerns. 4. Outline and explain key concepts related to Anatomy, Biochemistry, Histology, Microbiology, Osteopathic Manipulative Medicine (OMM), and Physiology within the framework of their respective curriculum.

Dr. Corley emphasized that the program and faculty want to cultivate a safe and nurturing environment for incoming students to practice goal-setting and self-reflection skills, assess the effectiveness of their learning and study habits, and improve the organization’s time management skills. They also want to establish individual class connections among students and build relationships with the faculty, staff, and other peers through large and small group interactions. Finally, they want to ensure the support did not end with the pre-matriculation program. So, in the support efforts, they want to ensure that the interventions targeted those who were academically at risk and identified the need for continual support.

Ms. Dearden then described the two groups of students participating in this pre-matriculation program, which were evenly divided in numbers between each group: Mandatory participation attendees based on application metrics, science GPA, biology MCAT Score—biology, and other factors, and Voluntary participation attendees choosing to attend to focus on alleviating study anxiety by increased preparedness for the academic and social rigors of medical school. She stressed that a carefully selected group of second-year OMS-II students serve as Teaching Assistants (TAs) and mentors in the pre-matriculation program and are essential to the program’s success. Approximately 20 students were hired: ten from SGL and ten from PBL. All second-year medical student mentors must have a minimum overall pre-clerkship exam average of 82. They are responsible for the following activities: developing and delivering curriculum content, breaking down curriculum content, teaching transferrable skills related to
curriculum content, facilitating small group discussions, and providing group and 1:1 mentoring. They also create and proctor quizzes, exams, practicums, and facilitator evaluations. She pointed out that it is unusual for them to be part of the core faculty but that, in doing so, they provide powerful role models of success for the incoming students. Ms. Dearden emphasized that the selection process focuses on mentoring skills and personal stories, including selecting some second-year student mentors who struggled during their first year.

Ms. Dearden discussed the ongoing support efforts to make sure that this, and other student support programs, targeted the interventions to those who were academically at risk and identified the need for continual support. For the PBL group, they created the longitudinal learning groups initiative, which follows them for the subsequent three blocks of their medical school career. For students in the SGL group, it has been administratively easier to check on their progress and ensure they’re receiving the support they need to do well by providing weekly support and review sessions. Their program objectives focus on entering medical students and creating a strong sense of membership and belonging through supportive personal connections. One of the running themes of their program is to make sure that
students, their mentors, and the faculty and staff on campus are connected. She stresses that they also wanted to ensure students demonstrated metacognitive skills to become learners and navigate the necessary personal and environmental adjustments to medical school. They give them time to practice the skill sets that they would need to do well in medical school, such as engaging in self-reflection, problem-solving, identifying knowledge gaps, and not being afraid that if they have gaps, whether it’s knowledge or skill-building, we want them to cultivate a growth mindset.

Ms. Dearden reviewed the program’s effectiveness as measured by the student’s performance in their first three blocks of curricula. The pre-matriculation participants demonstrated better organizational skills compared to non-participants. Data from the Learning and Study Strategies Inventory (LASSI) showed improved anxiety, attitude, information processing, self-testing, and time management. She also stated that the program had increased interest in voluntary attendance from entering students and a growing interest from faculty in presenting mini- lectures. However, as their program evolves, they have focused on reducing content to allow more practice and peer interaction, thereby increasing the one-on-one interactions. Finally, the pre-matriculation program intends to expand their second-year medical student TA training to incorporate more coaching techniques and more faculty input into the exams during the program.

Stigma in Medicine: The Power of Language
Presenters: J. Corey Williams, MD, MA, and Melissa Chen, MD

[The following blog was generated by Akshata Naik and Doug McKell]

Dr. Williams began the webinar by mentioning the work of the National Anti-Racism in Medicine Curriculum Coalition (NAMCC), a network of educators developing and teaching anti- racism curricula. He then described a vital issue for this presentation: identifying language stigmas in clinical documentation and providing solutions to rectify them. He stressed the importance of using non-stigmatizing, person-centered language in clinical documentation and oral presentations. Examples include avoiding terms like “non-compliant,” “alcoholic,” and “commit suicide” and embracing person-first language.

Dr. Williams presented a clinical vignette describing an elderly Hispanic veteran with a history of alcohol use disorder who attempted suicide. He asked the audience to identify all stigmatizing and extraneous language from the vignette that is irrelevant clinically, e.g., “alcoholic veteran,” “non-compliant,” etc. Dr. Chen then described how the language we use is also a proxy for talking about race and other socially marginalized identities. She outlined the survey results that focused on using race in clinical courses. When course directors were surveyed, they mentioned they were unclear about the circumstances under which they needed to teach about race. Due to the fear of being mis-speaking or misinterpreting, many course directors (18% of the participants) did not mention race. They also found that how and what clinical concepts were taught or mentioned in the patient notes varied depending on the race, training level, and the physicians/clinicians’ discipline.

Dr. Chen described a study from JAMA Internal Medicine revealing discrepancies in race documentation based on the patient’s race, diagnostician, and level of training. In this report, the chief medical resident at an academic medical center recorded, over two months, how frequently race or any unflattering characteristics such as non-cooperativity, irritation, and anger were used in the daily clinical presentation in hospital rounds. The study authors reported that race was more often specified prominently and repeatedly during presentations of Black patients or patients who belong to other racial minorities. Frequently, unflattering (biased) characteristics were mentioned in examples of unsheltered or patients suffering from substance abuse disorder in particular. Excerpts from the clinical notes also conveyed a sense of disbelief of the patient’s concerns, often when the patient’s symptoms were reported as
gossip rather than a factual experience linked to their condition. The hearsays were written in quotes, which they found to be more frequent while making notes on black patients with at least one or more judgment words, e.g., “Apparently…” or “Claims to..”.

Because care received by patients is directly related to how providers perceive patients, patients who are subject to stigmatizing language, phrases, and words are going to get care that is less effective, less efficient, and less needed when compared with someone who might be described in a more person-centered or neutral way. Because of the history of negative racial meanings in the US, this means that certain negative judgments or stereotypes will change the diagnostic thinking and treatment decisions of the patient in question. Drs. Williams and Chen reported a study to understand whether the words someone uses in charting patient details influence their diagnostic and treatment decisions. This study used an interesting methodology of exposing survey participants to a similar clinical vignette. The only difference was that one group received a neutral language vignette, while the other received a stigmatizing language. Students and residents who obtained vignettes with stigmatizing language had negative attitudes toward the patient. They were more likely to blame the patient for not having enough
will or not following an aggressive treatment plan. In another study, the race and sex of the patient affected the way cardiologists approached a treatment regimen. Women and black patients were less likely to be referred to thrombolytic therapy. Therefore, black women were the least likely among the groups to be recommended for this treatment. There was also a shocking revelation that many physicians thought that black patients had thicker skin or smaller brains despite absolutely no biological distinctions between the races. This study demonstrated that having false beliefs about biological differences based on race and the way the case was written with racial identifiers influenced the medical judgment of trained medical professionals.

Drs. Williams and Chen then addressed the need to be contemplative and reflective about how we treat our patients and how we talk about and record our interactions with patients. They stressed that talking about patients using person-first language rather than adjectives that label a patient as alcoholic or crazy needs to be baked into our medical training and our real-time direct patient care instruction of trainees. They suggested that we reflect on this – and act on this necessity – by thinking about whether the information we present about the patients is clinically relevant by asking ourselves: Does it mention a person’s race that this is not crucial information for their diagnosis or symptoms? Are we routinely labeling the patient with their disease condition, e.g., diabetic, alcoholic, etc.? Are we writing clinical notes in a way that blames the patient? Does it reinforce a stereotype? Does it contain pejorative or extraneous
language? Lastly, but most importantly, how would the patient feel if they read it, or how would you feel if your physician wrote about your sufferings using such a language? They argued that the clinic practices around identifying race in the patient’s chart significantly add to the disparities in which racial minorities are treated differentially in hospital systems.

Further, when a physician sees a racial minority identified in the chart, given the history of hostile and biased racial meanings, this may activate certain negative judgments with stereotypes that will inappropriately change the care providers’ diagnostic thinking and treatment decisions. They then provided examples of person-first language that could replace specific excerpts in physician’s notes. They also went on to list some of the resources they have curated that will aid medical and healthcare professionals and faculty in incorporating the training of using person-first language in their curricula.

This last point has become particularly salient in the previous five years since the passing of the 21st Century Cures Act, which increases access to patient health information and promotes patient choice. The law requires that healthcare organizations release electronic health information to patients as soon as it’s finalized. The Cures Act also prohibits information blocking when providers or hospital systems prevent patients from accessing, exchanging, or using their health information. As a result, patients are increasingly demanding access to their records, so we have to be more and more sensitive to what they would think if they were reading this documentation. So, what is this? Here are some examples of what person-first language looks and sounds like: Instead of saying a psychotic patient, for example, you would
say that a person is a person with psychosis, instead of saying a diabetic patient is a patient with diabetes. Instead of an alcoholic, this is a person with an alcohol use disorder or a substance abuse disorder. There’s also an essential point about saying that someone is or describing someone as female or male or non-binary, for that matter, versus saying someone is a woman or man; biologically speaking, describing someone as a female or male is to imply something about their genital anatomy and or their chromosomes, and when, in actuality, what we’re typically doing in most medical encounters is categorizing someone based on their outward physical appearance, which is culturally constructed notion. A culturally constructed notion of what we associate a man or woman typically looks like in our particular society, so using man or woman or non-binary are better descriptors for what we’re doing in the encounter, and unless, In rare instances, someone’s genital anatomy or chromosomes are relevant to the presenting concerns.

Both Drs. Williams and Chen continued with additional examples of incorrect language use, including the following: They noted that we often conduct urine drug screening in emergency rooms and hospitals, and, when doing so, we colloquially label them as dirty urine or clean urine when we should use terms like positive or negative screens. They suggested that we should also avoid terms like contact or felon. Instead, we should say the patient had a felony or was convicted, and this goes back to that person-first language that we went over earlier suicide. This terminology is particularly salient for mental health, so people bereaved by a loved one who died by suicide have highlighted in studies that using the words “committed” suicide can feel like casting judgment as commit is commonly used in conjunction with criminal acts, resulting in a negative connotation of immorality.

Dr. Williams concluded the presentation with a discussion of the original HPI case description he presented at the beginning of the webinar of Mr. W who is an elderly Hispanic, alcoholic veteran who presented to the hospital last night after he ran into traffic after what he claims was a two-week vendor, quote, unquote, he admits to being non-compliant with antidepressant medication he gets from his provider at the VA and had, unfortunately, relapse on alcohol after being cleaned for almost six months The revised HPI case description is of Mr. W who is a 57-year-old with alcohol use disorder who presented to the hospital last night after he tried to kill himself by running into traffic after experiencing a recurrence of his alcohol use he has been unable to feel prescribed antidepressant medication due to cost and had resumed using alcohol in the last two weeks after not using for almost six months. He pointed out that more helpful information was contained in the revised HPI. We can see the reason why he’ been off of his medication. We have a more precise timeline for how long he’s been able to maintain his recovery from alcohol, and then how long it’s been since he’s returned to use, and what were the specific events that led him into the let him into the emergency room.

AI Impact and Blowback
Presenter: Dennis Bergau, CEO, KarmaSci Scientific Consulting, LLC

[The following blog was generated by Doug McKell and Akshata Naik]

Dr. Bergau presented a brief overview of the existing AI landscape, followed by a more detailed review of evolving AI’s impact on medical education and the potential downstream blowback related to unintended consequences that may be overlooked, ignored, or unforeseen. Throughout his presentation, he emphasized the need for all users to adopt a critical evaluation of the existing and developing AI tools and technologies by acknowledging the imperfections that all systems have based on inherent biases and limits on the data they use to provide requested outputs.

Dr. Bergau covered the following areas during his presentation: How to identify and avoid AI reinforcing human biases in medical diagnosis and treatment, how to decide what should be the guardrails for using AI in undergraduate medical education, how to best educate medical students and faculty about AI, including whether to teach the technical details or focus on specific AI tools, the need to consider the environmental impact of increased AI usage and incorporate it into the cost-benefit analysis when discussing AI in medical education, consideration of ways to democratize access to AI tools and resources for medical students across different institutions, the opportunity to explore the use of digital twin concepts to teach medical, nursing, and other health professions students.

Dr. Bergau began his presentation by explaining AI by functionality, including reactive AI, limited memory AI, theory of mind AI, and self-aware AI. Dr. Bergau used an example of a comparison of five different models to illustrate the variability in AI model performance. He then discussed the concept of generative AI and its evolving applications in generating various forms of content. He specifically highlighted the role of transformer models in large language models (LLMs) and the concept of foundation models. Dr. Bergau discusses the potential and limitations of AI, including the idea of hallucinations in AI-generated content. He also emphasized the importance of setting realistic expectations for AI uses and performance, noting that there is a life cycle to all innovative advances elements. He then reviewed the benefits of AI in healthcare delivery, including faster drug and medical device development and assisting providers in accessing additional information for diagnosis and treatment decisions. He stressed the importance of not letting technology dictate societal norms and the need for flexible and applicable AI programs.

Dr. Bergau shifted his presentation to address AI’s existing and future challenges, including the evolving pace of technology, the need for ethical frameworks, and the potential for unintended consequences. Dr. Bergau emphasizes the importance of collaboration between IT and healthcare professionals to address AI biases and improve model accuracy. In response to a question from a webinar attendee, he also highlights the environmental impact of AI, including increased energy consumption and the need for sustainable solutions. One of the biggest challenges he sees in the future is the increased complexities of bias in AI resulting from human-generated data sets and the need for more and better representative training data sets to avoid unfair or unethical biases in the widespread application of AI tools and technologies.

Dr. Bergau discusses the need for AI literacy and the importance of understanding AI as a tool rather than a solution. He acknowledged the need for a common language between IT and healthcare professionals to integrate AI effectively into healthcare education. Doing so requires a better understanding of each discipline’s approach to the sources, quality., analysis, and expected utility of the information AI provides the user. He recognized that there are increasing questions about the future of AI in medical education, including the potential for AI avatars and the balance between personalized and generalized data. Central to this discussion is the need to decide how to educate entering medical school students about AI and what degree of knowledge (or competence) is necessary for their future practice experience in
clinical rotations and residency. Dr. Bergau stated that AI should be taught as a tool rather than a comprehensive subject, focusing on intelligent interaction with AI.

Looking forward, Dr. Bergau outlined the following considerations of AI in health professions education: The need for a partnership between AI users and IT/curriculum development will require developing a common language; AI literacy means going from using “buzz words” to a more accurate understanding of what AI is; Expert AI users and developers must be able to explain some of the complicated AI concepts to create shared knowledge, content balance, and transparency; It is critical to remember to focus on the problem you are trying to solve, not the AI solution, since AI is just one of many tools to be applied in healthcare learning and healthcare delivery; The application of and outcome from AI is different in biological or clinical uses that in predictive mathematical applications.

Dr. Bergau concluded by stressing that we must appreciate the different expectations and uses of AI applied to industry clinical trials, academic medicine, community medicine, UME, and GME, including different countries’ medical school curricula and learning formats worldwide. Finally, he challenged us to consider if and what programming skills/experience/ knowledge will be required competencies for all healthcare providers to use AI effectively in the future.

Approaching Curricular Reform
Presenters: Yerko Berrocal, MD, MHPE from Alice L. Walton School for Medicine, Kathryn Huggett, PhD from Larner College of Medicine at the University of Vermont, and Robert Opoka, PhD from Aga Khan University

[The following blog was generated by Doug McKell and Akshata Naik]

This seminar was co-presented by three speakers who presented different approaches to medical school curriculum design. They were Dr. Kathryn Huggett from an established medical school, Dr. Yerko Berrocal from a newly founded medical school, and Dr. Robert Opoka from an international medical school. Each presenter shared their perspective, expertise, challenges, and experience on curricular reform.

Dr. Kathryn Huggett began the webinar by highlighting information to help the audience prepare for curricular reform at their school. She stated that her goal was to identify critical considerations using evidence from literature and practical information to support curricular reform at other medical schools for schools considering curricular reform. This process requires careful pre-planning because of many interrelated components, especially during the evaluation and implementation stages. Dr. Huggett referred to several information resources and tools for effectively managing this process. She stated that curricular reforms are usually performed due to internal considerations, such as improving student learning outcomes and aligning assessments, or external considerations, such as matching updated accreditation standards and discipline-based organizational expectations. She emphasized that curricular reform involves evaluating what you teach and how you teach it. Several health professional organizations, including IAMSE, offer resources such as evidence-based active learning strategies, curricular objectives, assessment plans, and curricular objectives. For example, a curriculum committee could use the Universal Design Framework or the Integrated Course Design framework as a pedagogical foundation. Dr. Huggett recommended an excellent resource for curriculum development, “The Six-Step Approach to Curriculum Development” by Patricia Thomas, David Kern, and colleagues. Managing curricular reform is challenging at medical schools since one needs to implement a new curriculum while simultaneously delivering the current curriculum efficiently. She stresses that achieving a change of this magnitude means that administrators, instructional designers, curriculum coordinators, faculty, and students must be included in this process at the beginning, middle, and during the transition. She offered several ideas for executing this process, such as creating a task force and forming multidisciplinary committees, subcommittees, and working groups. Establishing effective communication strategies between various committees and working groups was also stressed.

One of the essential aspects of curricular reform is faculty support in terms of providing time and resources to undertake this process. Institutions and faculty must establish clear expectations regarding the type of support that will be provided, for whom, when, and for how long. For example, creating new course materials and valid assessments requires faculty time and understanding of evidence-based pedagogy. She stated that it is critical to understand that curricular reform is an iterative process where feedback needs to be collected, implemented, and evaluated. Dr. Huggett concluded by referencing two concepts as a reality check on curriculum progress. The first is the Zone of Feasibility, which includes the new teaching methods or policies that go beyond current practice but are realistic in the current context. The second is the Zone of Tolerance, defined as the amount of change the community will accept or tolerate. She stated that if the proposed changes in the Zone of Feasibility are more powerful than the Zone of Tolerance, they will likely be opposed. Although the zones cannot be quantified objectively and vary from school to school, acknowledging these forces is critical for successful curricular reform.

Dr. Yerko Berrocal discussed curricular reform at a new medical school, “Alice. L. Walton School of Medicine in Arkansas,” which will enroll its charter class in July 2025. It is a four-year innovative, evidence-based, integrated curriculum called ARCHES, which engages students via active learning. Dr. Berrocal acknowledged that many ideological battles are fought in the curricular reform process. He believes it is at this point when medical school faculty and administrators should ask themselves the following questions. What personal and professional qualities should our students develop? Where does foundational science belong in the curriculum – and why? What skill set and examination skills should be acquired – and how should we access them? How long will this take? What are the competencies and outcomes we should expect? Dr. Berrocal believes that a new medical school curriculum that has answered these questions can better prepare students for modern healthcare demands. It is built on a competency-based education that ensures students achieve specific competencies, including incorporating ongoing medical advancements.

Additionally, he stressed that a commitment to lifelong learning should be instilled in all medical students through curricular reform, especially because of the increased prevalence of chronic diseases and the importance of preventative medicine. Modern medical school curricula should also emphasize the importance of individual mental well-being, reduce stigma, and diminish burnout. Dr. Berrocal discussed the importance of considering learning theories while developing a curriculum. At his medical school, they used the six-step approach to curriculum development. Although there were several discussions and arguments regarding curricular reform creation, it was helpful to reach a consensus at the beginning from all faculty and stakeholders. All curriculum decisions should be made based on the school’s statement of
vision, mission, and values. Dr. Berrocal stressed that although following the six steps in numerical order is unnecessary, one needs to cover all six steps for effective curricular reform. He then described a few challenges one might face during curricular reform. First is the resistance to change by longstanding faculty members because they are set in how they teach, the modalities they use, and the assessments they have created. He also mentioned involving the admissions committee and enrollment department well in advance. Another challenge is ensuring the curriculum covers all topics without overwhelming students and meets the required accreditation standards. Another challenge is working with the diversity represented by students in each medical school cohort. He singled out the need to build in formative assessments to evaluate the new curriculum regarding the skills and competencies they teach our students. The data collected, analyzed and reported should inform any curricular change. Robust assessment and evaluation mechanisms must be an integral part of the change process to find areas of improvement in the curriculum on an ongoing basis. Additionally, schools must weigh the pros and cons of various available tools and technologies before implementing them into their curricula.

The final part of the webinar presentation was by Dr. Robert Opoka from Aga Khan University. Dr. Opoka stated that his medical school was especially interested in a curricular program that focused on using innovative methodologies that can set a standard for quality in the region. From the beginning, they had a clear goal to create a unique modern curriculum., Dr. Opoka reported that most established medical schools used a teacher-centered, classroom-based, lecture-based teaching method in their geographic region. In contrast, the newer medical schools have begun implementing a problem-based curriculum with smaller learning groups. At his medical school, the goal is to have a similar contemporary curriculum while retaining theories of learning relevant to their region and the common diseases and, at the same time, applicable worldwide. He also mentioned that these core values must be considered at the beginning of a curricular reform. However, they realized that although they were a 20-year-old medical school, they did not have the necessary infrastructure to develop their residency programs, specifically an educationally integrated hospital system. In the meantime, they focused on developing the medical school curriculum to engage all stakeholders, solicit feedback, and go through an iteration process, which was completed in 2020. They began by focusing on the infrastructure. The first step they made was to establish a teaching hospital. He stressed that it is essential to have medical education experts to help you as you develop and implement a curriculum so that they are not just part-time but fully committed and fully engaged people. They are now in the second year of implementing the new medical school curriculum, where the medical school programs in East Africa are six years, with students entering directly after high school. They started with 70 students per class, which they thought was manageable. The biggest challenge they faced was building better infrastructure. For example, if a library needed to expand and required more land, getting it approved was a big challenge. Another challenge was changing faculty and content expert mindsets about adopting educational innovations due to lack of time, sometimes lack of interest, and sometimes due to disagreements among themselves.

This seminar presentation was unique in the sense that attendees got a sneak peek into the
process of curricular reform from experts at schools with different levels of set curricula.

Disability in Medicine: Why We Need More Disabled Physicians
Presenter: Lisa M. Meeks, PhD, MA, the University of Michigan

[The following blog was generated by Doug McKell]

Dr. Meeks’ presentation focused on faculty and students’ roles in becoming aware of the importance of including disabled physicians and addressing ableism in medical education. She emphasized the need for anti-ableist training and policies to support disabled physicians as they can benefit everyone culturally by increasing empathy and innovation. Her presentation focused on individual and system initiatives to address our cognitive mindset limitations, which prevent us from being genuinely inclusive of providers with disabilities. Dr. Meeks challenged us to consider the manner and extent to which the healthcare system must be reformed. She shed light on the issue of regulations and accreditation standards not recognizing the contributions of healthcare providers with a disability, thus hindering institutions from implementing changes.

Dr. Meek asked the attendees three questions: How do we help students navigate these? Is there a way to help instill resilience or guide students to self-identify resilient qualities that will assist them as they move through medical education? Are there unique ways we can alter the system to help students, and are there other adjustments to think about to help students in this new age?

Dr. Meeks’ presentation began with a simple exercise: She asked everyone to write down what they think of when they hear or read the word “disability.” She reminded everyone that we all have subconscious cognitive scripts (ideas, beliefs, and emotions). These are modeled for us when, for example, we watch our parents or caregivers to see how they interact with other people or when we go on to school, and we’re taught what to think about what is “normal” and what is “not normal.” These cognitive scripts help us quickly organize our thoughts and actions by reducing our cognitive load when faced with multiple activities, persons, situations, and expectations. They are created by our individual experiences with different types of people and situations. Sometimes, they work for us to manage our social world successfully, and sometimes, they work against us by creating artificial boundaries in our social expectations of other people’s abilities.

Dr. Meeks asked the attendees to fill in the blank with their first reaction to three clinical scenarios: 1. A physician with ADHD is likely to (fill in the blank). 2. A physician who’s a wheelchair user will (fill in the blank). 3. A physician with dyslexia will (fill in the blank). She then described the work of her research team using AI to list the common synonyms for the term disability, and they included cognitive impairment, incapacitation, intellectual disability, limitation, restriction, damage, disadvantage, and incapacity, which are all very negatively charged words. She noted that AI uses data from every published information source, including general commentaries, cultural histories and stories, behavioral norms, academic research, and social media. It is accessing all of this data and organizing the ideas we, as humans, have publicly shared. She noted that the result is a disturbing and humbling reflection on what society believes about disability.

Dr. Meeks narrowed her focus to a core issue that affects all disability work: the concept of ableism. “Access Living” defines ableism as discrimination of and social prejudice against people with disabilities based on the belief that a regular body and mind are preferred, and it’s the preferred body and mind that society places this value on. At its heart, it’s rooted in the assumption that disabled people require fixing and that their disability defines them. As a result, we often hyper-focus on the disability, which may be the first thing we consider when working with a patient, a medical school applicant, or a resident. It may be the only thing we see when working with a learner. In this way, ableism generalizes people with a disability, observable or hidden, and reduces them to a limitation. It is very similar to acts like racism and sexism, where we take entire groups of people and assign them to a lesser value, creating harmful stereotypes with negative descriptions. The misconceptions that go with these generalizations significantly limit our understanding of individuals based on either being classified as disabled or by their diagnosis. Dr. Meeks challenged the attendees to recognize how disability ableism contributes to oppression in our healthcare systems and our healthcare education spaces because ableism is looking at an idealized mind-body relationship and assigning more positive value to it than what is the reality of a dialable person’s actual abilities.

Dr. Meeks shifted her discussion to inequities in the healthcare system due to disability challenges based on stereotypes and limited accessibility. Poor health outcomes of people with disabilities are due to systemic healthcare inequities and not due to their disability. Research evidence shows that people with disabilities are less likely to get regular health screenings and more likely to experience diagnostic overshadowing, defined as dismissing their symptoms by relating them to the person’s disability. That is why we often miss diagnoses in people with disabilities.

Dr. Meeks then shifted to describing the benefit of having disabled doctors, disabled nurses, disabled physical therapists, and other disabled healthcare providers for patient care, which can help reduce some of the existing poor health outcomes for patients with disabilities. Her research group has built a healthcare delivery model for improved disability services using contact theory. The core concept is that interaction with a student or a professional with a disability challenges your perception of people with disabilities and what they’re capable of in a unique and personal way. It directly confronts the ableism belief that people with disabilities are unemployed (or unemployable), that they have a poor quality of life, and that they’re all unhappy. In her research service, when healthcare trainees work, learn, and socialize with persons with a disability, this process challenges the trainee’s stereotypes and assumptions, i.e., limitations, about people with a disability. This is a counter-narrative to this very embedded, deeply ingrained ableist construct. In the process, everyone will begin to think differently about people with disabilities, and doing so will help inform and improve patient care.

Dr. Meeks then described some advantages of training disabled physicians and other health professionals. First and foremost is increased empathy. Her research has demonstrated that in a training situation where empathy erodes over time, for abled trainees, empathy doesn’t erode for disabled physicians and disabled individuals. It may be that the experience of having a disability and being driven to become a healthcare professional because of that experience allows that person to have more empathy because they’ve been there. She reported that disabled clinicians talk all the time about being on both sides of the bed or both sides of the stethoscope. Disabled physicians contribute to innovation, and many hold patents for devices they developed from their experience of receiving care that improves\ care-providing experiences for patients and their physicians.

About 9.3% of undergraduate medical education learners and about 11.8% of medical residents, but only 3% of physicians are identifying as disabled, meaning there’s a tremendous drop-off in self-reporting. When Dr. Meeks and her team researched this issue, they found that physicians with disabilities are subject to a higher frequency of being mistreated, both by patients and their peers, which adds to and exceeds the existing professional and personal stress in our physician population. They found that physicians with disabilities are more burnt out due to the current ableism belief system and lack of education for those in leadership positions. She reported that many individuals in leadership positions don’t fully understand disability or the benefits of having disabled practitioners and don’t have the education or resources to fully understand how to support their physicians and other disabled health practitioners. Additionally, disabled physicians and other health professionals are experiencing a lack of accommodation. On the bright side, their research showed that when people have accommodation, it mitigates their intent to drop out of caregiving.

Dr. Meeks concluded her presentation by stating that, as a society, we have created idealized values, norms, and traditions of what are considered normal abilities, i.e., necessary, in medicine and healthcare that we routinely reinforce. Similarly, our structures and systems are designed to reinforce these, limiting our disabled providers. In many ways, the ablest beliefs, actions, and the words we use are unconscious. But it doesn’t matter whether it’s an unconscious or intentional action, as it still has a significant impact on our learners, and some of that impact includes low numbers of qualified disabled practitioners. As a result, fewer disabled but qualified people apply and are admitted to medical schools, resulting in fewer disabled but qualified individuals practicing medicine. These low numbers are due to incorrect beliefs about disabled students and their needs and the lack of accommodation process. It is also a result of the assumption that disabled people are not going to be part of our professional communities, which then creates fewer individuals with higher-degree career expectations or lowers career expectations for potentially great healthcare professionals with disability. Her final suggestion was to continue our education about the potential for individuals with all types of disability to flourish in healthcare. Ask questions when you don’t know the answers, as most disabled people want you to ask them to reach a better understanding of how to provide the most
effective support possible.