Josiah Macy Jr. Foundation Conference on COVID-19 and the Impact on Medical and Nursing Education: Conference Recommendations Report

Using Group Concept Mapping to Explore Medical Education's Blind Spots

PHENOMENON

All individuals and groups have blind spots that can lead to mistakes, perpetuate biases, and limit innovations. The goal of this study was to better understand how blind spots manifest in medical education by seeking them out in the U.S.

APPROACH

We conducted group concept mapping (GCM), a research method that involves brainstorming ideas, sorting them according to conceptual similarity, generating a point map that represents consensus among sorters, and interpreting the cluster maps to arrive at a final concept map. Participants in this study were stakeholders from the U.S. medical education system (i.e., learners, educators, administrators, regulators, researchers, and commercial resource producers) and those from the broader U.S. health system (i.e., patients, nurses, public health professionals, and health system administrators). All participants brainstormed ideas to the focus prompt: "To educate physicians who can meet the health needs of patients in the U.S. health system, medical education should become less blind to (or pay more attention to) …" Responses to this prompt were reviewed and synthesized by our study team to prepare them for sorting, which was done by a subset of participants from the medical education system. GCM software combined sorting solutions using a multidimensional scaling analysis to produce a point map and performed cluster analyses to generate cluster solution options. Our study team reviewed and interpreted all cluster solutions from five to 25 clusters to decide upon the final concept map.

FINDINGS

Twenty-seven stakeholders shared 298 blind spots during brainstorming. To decrease redundancy, we reduced these to 208 in preparation for sorting. Ten stakeholders independently sorted the blind spots, and the final concept map included 9 domains and 72 subdomains of blind spots that related to (1) admissions processes; (2) teaching practices; (3) assessment and curricular designs; (4) inequities in education and health; (5) professional growth and identity formation; (6) patient perspectives; (7) teamwork and leadership; (8) health systems care models and financial practices; and (9) government and business policies.

INSIGHTS

Soliciting perspectives from diverse stakeholders to identify blind spots in medical education uncovered a wide array of issues that deserve more attention. The concept map may also be used to help prioritize resources and direct interventions that can stimulate change and bring medical education into better alignment with the health needs of patients and communities.

Lost in the pandemic: COVID-19's impact on health professions educators

BACKGROUND

Minimal research has explored the pandemic's impact on health professions educators (HPEs). Given that health professions educator academies provide centralised support and professional development to HPEs through communities of practice and promoting education at their institutions, it is important to examine how academies met HPEs' needs during the pandemic. This study investigates the COVID-19 pandemic's effects on HPEs and examines how academies supported HPEs' educational roles during the pandemic.

METHODS

Using a mixed-methods approach, the authors surveyed United States educator academy members on changes in HPEs' activities, emphasising clinical and educational tasks and work-life integration. Participants shared their academies' innovations and support responses. Data were analysed using chi-square and content analyses.

FINDINGS

Twenty percent of 2784 recipients (n = 559) completed the survey. Most respondents indicated the pandemic caused them to spend more time on clinical and education leadership/administration than before the pandemic. HPEs integrated innovative instructional strategies, yet many shifted away from teaching, mentoring and scholarship. Over half were dissatisfied with work-life integration during the pandemic. Females, especially, reported that professional work was compromised by personal caregiving. Academies increased their range of member services; however, they did not fully meet their members' needs, including providing expanded professional development and advocating on HPE's behalf for increased protected time dedicated to educator responsibilities.

DISCUSSION

HPEs faced unprecedented challenges in their personal and professional lives during the COVID-19 pandemic. Neglecting the needs of HPEs amidst global crises poses a substantial threat to the quality of education for upcoming generations of health care professionals.

Academic Health Centers and the Quintuple Aim of Health Care

The Quintuple Aim of health care adds health equity to the existing Quadruple Aim of improving the individual experience of care for patients, improving the health of populations, reducing the per capita cost of care, and improving the experience of health care professionals. Health equity has previously been subsumed within the other 4 aims. Elevating health equity to the status of a distinct aim is necessary to address persistent health inequities that disproportionately affect underrepresented and minoritized groups. Academic health centers (AHCs) bear a unique responsibility to advance health equity due to the societal importance of their 4 missions: patient care, education, research, and community collaboration. Interprofessional education and practice provide natural connection points that enable AHCs to prepare both health professions students and practicing health care professionals to address all 5 aims. AHCs are well positioned to assess health outcomes related to health equity, develop a health care workforce that is representative of their communities, develop innovative research questions regarding health equity, and engage and invest in the communities they serve.