Blog

  • Communication

    In Turbulent Times, Thoughtful Change Management Minimizes Chaos and Resistance

    This blog deviates a bit from our normally discussed topics on the #MedEdChat blog. Recently, I’ve spent time working with two organizations on strategic planning, and change management has been front and center in my mind. After a recent negative experience with proposed changes that arose after the planning process, I felt a need to discuss this topic.

    Organizational change is inevitable, but the way it is enacted has profound implications for the people who make up that organization’s community. This is especially true in academic and professional organizations, where individuals often form a deep sense of belonging and identity—an “academic home.” When change is delivered abruptly, without meaningful consultation, explanation, or consideration of members’ lived experiences, the disruption can extend far beyond operational adjustments (1). It can challenge long-standing values, weaken trust, and erode the very affinity that binds a community together.

    The psychology of the practicing physician (and scientists) is predicated on the emphasis on autonomy. In fact, autonomy, mastery, and purpose may be more important motivators than things like salary and incentives. Evidence demonstrates that the perception of the lack of control at work is associated with burnout, or intentions to leave that organization (2). The costs to an organization associated with replacing a physician are not insignificant.

    Effective change management recognizes that transitions are not merely technical shifts; they are human processes that depend on transparency, communication, and shared purpose (1). Research across medical education, healthcare, and organizational science demonstrates that successful change efforts are grounded in early engagement with stakeholders, clear articulation of the rationale for change, and intentional attention to culture (3). When members understand not only what is changing but why, they are better able to situate the transition within the organization’s broader mission.

    Conversely, when change is imposed in an autocratic manner, several predictable consequences emerge. Stakeholders feel unheard or devalued, leading to disengagement and frustration. Resistance can then arise not because people oppose progress, but because they have not been given the opportunity to contribute perspectives that could improve the change effort and mitigate harm (3,4). Most critically, trust—one of the most important currencies of any organization—can be damaged when decisions appear opaque or misaligned with the community’s identity. This loss of trust can endure long after the operational change is complete.

    Thoughtful change management requires leaders to approach transitions with deliberate care (5). Listening to stakeholder voices, acknowledging the emotional impact of change, communicating early and consistently, and remaining open to adjustment are essential actions by leaders that honor the expertise and commitment of those who volunteer their time to make the organization a success. When organizations treat change as a collaborative process rather than an announcement, they strengthen their culture rather than destabilize it.

    As leaders reflect on recent decisions and consider future steps, consulting the various change management models available may minimize future missteps (4-6). When change management is not considered, the following questions might help recovery:

    • Why were stakeholders disregarded in the decision-making process, and how can they be intentionally incorporated going forward?
    • How did the change affect stakeholders’ sense of identity, belonging, or academic home within the organization?
    • In what ways has trust been weakened or broken, and what specific actions are needed to rebuild it?

    References

    1. Practical Pschology. Lewin’s Change Theory (Definition + Examples). 2020. Available at: https://practicalpie.com/lewins-change-theory/. Accessed November 7, 2025.
    2. Sinsky CA, Brown RL, Rotenstein L, Carlasare LE, Shah P, Shanafelt TD. Association of Work Control With Burnout and Career Intentions Among U.S. Physicians : A Multi-institution Study. Ann Intern Med. 2025 Jan;178(1):20-28. doi: 10.7326/ANNALS-24-00884.
    3. Karimi E, Sohrabi Z, Aalaa M. Change Management in Medical Contexts, especially in Medical Education: A Systematized Review. J Adv Med Educ Prof 2022; 10(4):219-227. DOI: 10.30476/JAMP.2022.96519.1704
    4. Banerjee Y, Tuffnell C, Alkhadragy R. Mento’s Change Model in Teaching Competency-based Medical Education. BMC Med Educ 2019; 19:472. DOI. 10.1186/s12909-019-1896-0
    5. Prosci. What Is Change Theory? Definition and Applications Explained. 2025. Available at https://www.prosci.com/blog/change-theory. Accessed November 7, 2025.
    6. Harrison R, Fischer S, Walpola RL, Chauhan A, Babalola T, Mears S, Le-Dao H. Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. J Healthc Leadersh 2021; 13:85-108. DOI: 10.2147/JHL.S289176

    Author: Gary L. Beck Dallaghan, Ph.D.; Council on Medical Student Education in Pediatrics

  • Faculty Development

    Optimizing Faculty Engagement in Education: Solutions and Barriers

    Physician faculty are critical to medical student learning.  From classroom education, which may include didactics or facilitating small group discussions, to clinical experiences in hospitals or outpatient clinics, to mentorship and administrative roles, physician educators are at the pulse of the student experience.  

    Though quality medical education is critical for training the future physician workforce, academic faculty must balance a myriad of competing demands. Physician salaries are typically driven by clinical productivity, whereas teaching and other efforts to support academic missions may be unfunded.  Additional barriers to teaching include time constraints, limited space in the clinic, a lack of confidence or experience on the part of the clinical teacher, bureaucratic rigmarole surrounding student onboarding, volunteer faculty paperwork, , meeting dynamic Liaison Committee for Medical Education Requirements, and completing cumbersome grading forms, just to name a few.  

    As medical student enrollment continues to increase, from 85,122 in 2014-2015 to 99,562 in 2024-2025 [1], additional faculty and clinical training sites are needed to accommodate these learners.  An all hands on deck approach is necessary to ensure continued medical education quality.  This includes optimization of academic faculty teaching, recruitment of additional faculty, and expansion of training sites outside of the home institution.  Already- stretched academic faculty may feel pressure to take on additional students without additional incentive and risk site overcrowding.  Expansion of training sites often means reliance on volunteer, non-salaried faculty in the community.  As such, strategies to motivate and incentivize faculty to undertake medical student education activities become increasingly important. [2, 3]

    While increased student numbers may have exacerbated the need for volunteer faculty, the need for volunteer clinical educators is hardly new.  The Alliance for Clinical Education (ACE) published guidelines on recruiting and retaining community-based faculty to teach medical students nearly 10 years ago [4].  ACE highlights practical teaching strategies that can be leveraged in the community setting, including increasing student involvement and value to the care team by identifying tasks for which the student is responsible; this could include patient check-in, medication reconciliation, updating the patient history, or helping with post visit follow-up [4]. ACE also highlights potential benefits to preceptors including prestige or resources through medical school affiliation, and marketing benefits [4]. 

    Institutions also have a role in developing a culture of educational commitment.  Some schools have adopted Educational Value Units (EVUs) to help capture educational efforts.  A review from Husain, Chen and Lelli (2023) suggests that EVU implementation can have a wide impact.  Institutions noted a wide range of impact types when EVUs were introduced, including redistributed teaching responsibility, increased conference attendance, increased evaluation completion, increased teaching productivity, increased mentorship, increased peer-reviewed publications, increased leadership in academic organization, increased external funding and redistribution of funds within and between departments [5].  While paying physicians to teach has been shown to improve educational experiences for learners [6], funding availability and allocation can be fraught.  If faculty time cannot be reimbursed, bonus structures that financially incentivize teaching may be helpful, as demonstrated at the University of Nebraska Medical Center. 

    Institutions can foster faculty confidence and teaching skills.  This may be through supporting travel or CME funding for education-focused conferences, through institutional faculty development presentations on educational pearls and best practices, and through valuing teaching efforts in promotion and tenure processes [2-4].  

    Additionally, medical colleges can be mindful to streamline paperwork requirements, removing redundant or ambiguous grading questions, and simplify the student evaluation process [2]. Faculty should be provided with clear objectives for students and given autonomy to meet these expectations through methods that are most appropriate to their care setting.  Simulation activities can be employed to ensure that key elements are covered and alleviate pressure from faculty and training sites, which often emphasize different skills or serve specific patient populations.   Examples of simulation activities include standardized patients, manikins, or virtual modules.

    Furthermore, institutions should ensure faculty understand the breadth of clinician educator opportunities available.  Although most physicians equate medical education with direct teaching, there are many other roles in education including mentoring and administrative roles such as clerkship directors or pre-clinical course directors that may be of interest to faculty and play to different faculty strengths. 

    Nationally, specialty boards certifications should also support CME and Maintenance of Certification opportunities to reflect educational quality improvement work undertaken as educators, akin to clinical performance improvement activities.  Additionally, several states now offer tax incentives for clinical precepting [7], or enhanced Medicaid payments which may help offset perceived financial impact without directly impacting medical school budgets. 

    In summary, the need for physician educators is chronic and growing.  Despite barriers, opportunities exist at the departmental, institutional, and national levels that can be employed to help mitigate these barriers.  With increasing demands on physicians and rising numbers of medical students, ongoing attention must be paid to ensure physician faculty are motivated and empowered to train the next generation. 

    What do you think?  Here are some questions to consider:

    • How can institutions balance clinical and educational needs? What strategies could align both? 
    • What do you think is most likely to motivate physicians to engage in teaching?
    • What bureaucratic barriers do you think have the biggest impact on physicians’ willingness to teach and how could these be streamlined?
    • How can institutions ensure that expanding training sites to community settings with volunteer faculty have high educational quality and satisfaction from both the physician educator and the student?

    References:

    1. Boyle P. Medical school enrollment reaches a new high [Internet]. Washington (DC): Association of American Medical Colleges; 2025 Jan 9 [cited 2025 Oct 1]. Available from: https://www.aamc.org/news/medical-school-enrollment-reaches-new-high
    2. Theobald M. STFM tackles preceptor shortage. Ann Fam Med. 2016 Mar;14(2):183-4. doi:10.1370/afm.1917.
    3. Hobson WL, Olson LM, Hopf HW, Winter LC, Byington CL. “The adjunct faculty are our lifeblood”: an institution’s response to deliver value to volunteer community faculty. Fam Med. 2021;53(2):133-8. doi:10.22454/FamMed.2021.565994.
    4. Christner JG, Dallaghan GB, Briscoe G, Casey P, Fincher RM, Manfred LM, Margo KI, Muscarella P, Richardson JE, Safdieh J, Steiner BD. The community preceptor crisis: recruiting and retaining community-based faculty to teach medical students—a shared perspective from the Alliance for Clinical Education. Teach Learn Med. 2016 Jul-Sep;28(3):329-36. doi:10.1080/10401334.2016.1152899. Epub 2016 Apr 19. PMID:27092852.
    5. Husain A, Chen DA, Lelli GJ. A review on the use of the Educational Value Unit (EVU) among teaching hospitals. Healthcare (Basel). 2023;11(1):136. doi:10.3390/healthcare11010136
    6. Ashar B, Levine R, Magaziner J, Shochet R, Wright S. An association between paying physician-teachers for their teaching efforts and an improved educational experience for learners. J Gen Intern Med. 2007 Oct;22(10):1393-7. doi:10.1007/s11606-007-0285-2. Epub 2007 Jul 26. PMID: 17653809; PMCID: PMC2305849.
    7. Smith T. An update on state preceptor tax incentives: Where do we stand? [Internet]. Washington (DC): Physician Assistant Education Association; 2023 Oct 28 [cited 2025 Oct 1]. Available from: https://paeaonline.org/resources/public-resources/paea-news/an-update-on-state-preceptor-tax-incentives-where-do-we-stand

    Authors: Dana Raml, M.D.; Mary Steinman, M.D.; & Linda Love, Ed.D.; Association of Directors of Medical Student Education in Psychiatry

  • Grading

    Let’s Stop Calling It “Competency-Based Medical Education”

    Health professions education has a love for buzzwords. One of the most persistent, and arguably misleading, is “competency-based medical education” (CBME). It sounds progressive, rigorous, and student-centered (Boyd et al., 2015). However, the first question that comes to mind is “Did we graduate incompetent physicians before this movement?” And, if we’re being honest, what we call CBME today is not truly competency-based.

    So, what is competency-based medical education? According to Frank et al. (2010), competency-based education in medicine can be defined as “an educational approach that organizes the curriculum around defined competencies—observable abilities that integrate knowledge, skills, and attitudes—emphasizing outcomes rather than processes, and allowing learners to progress upon demonstration of competence rather than fixed time [Italics added for emphasis]”. The key element here is flexibility: in a true CBME system, time becomes a variable, and learners advance when they demonstrate mastery, not when the calendar dictates.

    In the current U.S. system of health professions education, time is fixed, regardless of how quickly learners master core competencies. Residents complete training in fixed durations—three years for internal medicine, five for surgery—with advancement (and the funding of many of the slots) tied to time-based milestones, not individual proficiency. Even if a resident demonstrates competence in all required entrustable professional activities (EPAs) by year two, they cannot graduate early. Conversely, if a learner struggles, extensions are rare and often stigmatized. So can we truly say this is competency-based?

    This time-based rigidity means that while competencies inform curricula, assessments, and evaluations, they do not govern progression. What we have then is competency-informed education. This isn’t just semantics; it’s about intellectual honesty. Calling our system “competency-based” implies a level of flexibility and learner-centeredness that we haven’t achieved. It sets expectations we don’t meet. And it undermines the very definition of competence.

    Language shapes policy. It influences accreditation standards, curriculum design, and public perception. If we want to be taken seriously as educators and reformers, we need to be precise. We should call our current model what it is: competency-informed medical education. That term acknowledges the value of competencies without pretending we’ve restructured the entire system around them.

    So what would it take to move from competency-informed to competency-based? We need to create flexible pathways, modular curricula, and assessment systems that allow learners to progress when they’re ready. This would take resources, which are often not available, and significant changes to the “rules” of accreditation and the funding underlying the processes. So until then, maybe we should stop using a term that doesn’t reflect reality.

    What do you think? Here are some questions to ponder:

    1. What barriers—cultural, logistical, economic, or regulatory—prevent us from implementing truly time-variable education in medical training?
    2. Are we unintentionally misleading stakeholders (students, faculty, accreditors, the public) by using the term “competency-based” inaccurately?
    3. What would it take—structurally and philosophically—for medical education to become truly competency-based rather than competency-informed?

    References

    Boyd VA, Whitehead CR, Thille P, Ginsburg S, Brydges R, Kuper A. Competency-based medical education: the discourse of infallibility. Med Educ 2018; 52: 45-57. https://doi.org/10.1111/medu.13467

    Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. (2010). Toward a definition of competency-based education in medicine: a systematic review of published definitions. Med Teach 2010; 32(8): 631–637. https://doi.org/10.3109/0142159X.2010.500898

    Author: Gary L. Beck Dallaghan, Ph.D.; Alliance for Clinical Education

  • Learning Environment

    Prevalence, Sources, and Reporting Barriers of Mistreatment Among Medical Residents and Fellows: Implications for Trainee Well-being and Patient Care

    Mistreatment of medical residents and fellows—including verbal abuse, sexual harassment, discrimination, and microaggressions—continues to be a widespread and complex issue in teaching hospitals. Recent large-scale studies have shown that as many as 59% of trainees encounter at least one form of mistreatment during their training. Among these, verbal harassment is the most frequently reported, followed by discrimination and sexual harassment. Female residents and those from minoritized backgrounds are disproportionately affected, facing higher incidences of public humiliation, sexist remarks, and unwanted sexual advances [1–3].

    The clinical learning environment is characterized by a hierarchical structure and high-pressure dynamics, which contribute to various sources of mistreatment. While faculty and attending physicians are the most commonly identified perpetrators, mistreatment also originates from colleagues, nurses, interprofessional team members, and even patients and their families [3,5–7]. Particularly concerning are microaggressions, which often stem from patients and staff. These are significantly underreported, yet can accumulate over time, severely affecting trainees’ psychological safety and professional identity [5,8].

    The consequences of mistreatment are severe. It is strongly linked to burnout, anxiety, depression, and even suicidal ideation among trainees. Additionally, it compromises team performance and patient care quality [2–3]. Despite institutional efforts to tackle the issue, reporting rates remain low, with fewer than 25% of mistreated trainees submitting formal reports. Key barriers include fear of retaliation, lack of confidentiality, and distrust in the system’s ability to bring about meaningful change [2,9,10]. Interestingly, anonymous climate surveys routinely reveal much higher prevalence rates than institutional reports, underscoring the depth of underreporting [1,9].

    Various interventions have been implemented to address mistreatment, such as policy changes, establishing ombuds offices, enhancing reporting systems, and conducting educational workshops. However, the quality of evidence supporting the effectiveness of these interventions is often low. Most programs have not shown lasting improvements, particularly in reducing sexual harassment [11]. 

    Moving forward, it is essential for institutions to co-design policies and reporting mechanisms in collaboration with residents, ensure confidentiality, and commit to transparent follow-up. Program directors and hospital leaders must foster a culture of accountability and support, while policymakers should enforce robust, anonymous reporting systems and mandate regular climate assessments. Only through sustained, systemic reform can the clinical learning environment become safer and more inclusive for all medical trainees.

    Here are some questions to consider yourselves…

    1. Why do you think mistreatment of medical trainees remains so prevalent despite institutional efforts to address it? What systemic or cultural factors might be perpetuating this issue?
    2. How might the hierarchical nature of medical training contribute to underreporting of mistreatment? What changes could help dismantle this power imbalance?
    3. If you were a medical resident experiencing microaggressions or harassment, what barriers would prevent you from reporting it? How could institutions make reporting safer and more effective?
    4. What role do non-physician staff (e.g., nurses, patients) play in the mistreatment of trainees? How can interprofessional collaboration be improved to foster a more respectful environment?
    5. Beyond policy changes, what cultural shifts are needed in medical education to ensure trainees feel psychologically safe and supported?

     

    References

    1. Hammoud MM, Appelbaum NP, Wallach PM, Burrows HL, Kochhar K, Hemphill RR, Daniel M, Clery MJ, Santen SA. Incidence of resident mistreatment in the learning environment across three institutions. Med Teach. 2021 Mar;43(3):334-340. doi: 10.1080/0142159X.2020.1845306.
    2. Gianakos AL, Freischlag JA, Mercurio AM, Haring RS, LaPorte DM, Mulcahey MK, Cannada LK, Kennedy JG. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg. 2022 Jul;46(7):1587-1599. doi: 10.1007/s00268-021-06432-6.
    3. Hu YY, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT, Potts JR 3rd, Buyske J, Hoyt DB, Nasca TJ, Bilimoria KY. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 2019 Oct 31;381(18):1741-1752. doi: 10.1056/NEJMsa1903759.  
    4. Fnais N, Soobiah C, Chen MH, Lillie E, Perrier L, Tashkhandi M, Straus SE, Mamdani M, Al-Omran M, Tricco AC. Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad Med. 2014 May;89(5):817-27. doi: 10.1097/ACM.0000000000000200.
    5. Alimi Y, Bevilacqua LA, Snyder RA, Walsh D, Jackson PG, DeMaria EJ, Tuttle JE, Altieri MS. Microaggressions and Implicit Bias in Surgical Training: An Undocumented but Pervasive Phenomenon. Ann Surg. 2023 Jan 1;277(1):e192-e196. doi: 10.1097/SLA.0000000000004917.
    6. Chadaga AR, Villines D, Krikorian A. Bullying in the American Graduate Medical Education System: A National Cross-Sectional Survey. PLoS One. 2016 Mar 16;11(3):e0150246. doi: 10.1371/journal.pone.0150246.
    7. Grover A, Appelbaum N, Santen SA, Lee N, Hemphill RR, Goldberg S. Physician mistreatment in the clinical learning environment. Am J Surg. 2020 Aug;220(2):276-281. doi: 10.1016/j.amjsurg.2019.11.038.
    8. Jagsi R, Griffith K, Krenz C, Jones RD, Cutter C, Feldman EL, Jacobson C, Kerr E, Paradis KC, Singer K, Spector ND, Stewart AJ, Telem D, Ubel PA, Settles I. Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine. JAMA. 2023 Jun 6;329(21):1848-1858. doi: 10.1001/jama.2023.7232. 
    9. Sahiti Q, Shearer C, Thomson C, Sutherland L, Bowes D. Addressing medical resident mistreatment: A resident-centred approach. Med Teach. 2024 Jun;46(6):769-775. doi: 10.1080/0142159X.2023.2279903.
    10. Leitman IM, Muller D, Miller S, Hanss BG, Catron TF, Cooper WO, Filizola M. Implementation of an Online Reporting System to Identify Unprofessional Behaviors and Mistreatment Directed at Trainees at an Academic Medical Center. JAMA Netw Open. 2022 Dec 1;5(12):e2244661. doi: 10.1001/jamanetworkopen.2022.44661.
    11. Gupta A, Thompson JC, Ringel NE, Kim-Fine S, Ferguson LA, Blank SV, Iglesia CB, Balk EM, Secord AA, Hines JF, Brown J, Grimes CL. Sexual Harassment, Abuse, and Discrimination in Obstetrics and Gynecology: A Systematic Review. JAMA Netw Open. 2024 May 1;7(5):e2410706. doi: 10.1001/jamanetworkopen.2024.10706.

    Authors: Sumayah Abed, M.D.; B. Earl Salser, Jr., M.D.; Society of Teachers in Family Medicine

  • Workforce

    Are Medical Schools Biased Against Pediatrics and Primary Care?

    There is a brewing pediatric and other primary care workforce crisis on the horizon.  In a 2013 Policy Statement, the American Academy of Pediatrics warned that “the current pediatrician workforce is not meeting the primary care…needs to provide quality healthcare for US children” (1).  From 2017-2023, the percentage of filled pediatric residency spots remained consistent between 97% and 98%.  However, in 2024, that percentage fell dramatically to 92% (2).  Although the 2025 pediatric match did see an increase in filled spots (95%), it remained below those levels seen from 2017-2023 (3).  Family Medicine has seen a similar trend (4).

    These alarming trends are likely multifactorial: 73% of medical students have a debt load and 31% also had debt from undergraduate studies.  In 2024, the average medical school debt (excluding undergraduate costs) was $235,000 (5)!  The disparity between Medicaid (predominantly children) and Medicare (predominantly adults) payments to providers, along with pediatrics being one of the lowest paid specialties surely play a major role.  A 2024 survey by Weatherby Healthcare reported that pediatricians were the second lowest earning specialty (6).  A recent compensation report noted that “a solid majority of pediatricians believe they are underpaid and are unhappy with their pay” (7).  In addition to these economic factors, is it possible that medical schools share some blame for fewer students entering pediatrics and primary care?

    While most medical schools publicly recognize the importance of primary care, their actions and institutional culture often tell a different story. One study by researchers from the Council on Medical Student Education in Pediatrics (COMSEP) found that almost half of medical students considered pediatrics at one point in their training.  However, the majority chose another specialty (8).   A significant reason for this shift could be the subtle—and sometimes overt—biases students encounter during training.  Medical school education has traditionally been organized in a manner that “prioritizes certain specialties and disciplines” (9).  Academic centers that receive more NIH funding tend to produce fewer graduates entering primary care (10).   There may also be a perceived prestige issue. During my training, I sometimes felt as though specialties like dermatology, radiology, surgery, and orthopedics were often portrayed as more intellectually challenging, hence more respected. Faculty and mentors may unintentionally reinforce this by praising students who pursue competitive specialties while downplaying the value of generalist fields (11). Students may then regard a career in primary care is a “fallback” rather than a first choice.  I recall an experience I had during my 4th year while doing an elective in Pediatric Urology.  I had already made the decision to pursue pediatrics, so I felt an elective in Peds Urology would be valuable.  One day in the OR, the attending urologist asked me what specialty I was going to pursue.  When I told him pediatrics, he remarked “what a waste”.

    What about the pre-clinical curricula?   Studies from COMSEP researchers found that nearly one-third of students felt that their pre-clinical education was poor or fair in preparing them for the pediatric clerkship (12) and that most medical schools had 0-3 hours total in the pre-clinical curriculum addressing pediatric history and physical diagnosis (13).  Another COMSEP study that surveyed 525 medical students from four different schools found that only one of the schools had a pediatric themed lecture in all the second year system-based courses, one had a variable amount, and two had no pediatric themed lectures in each second year system-based course (14) .  Many medical schools have decreased their pediatric clerkship time down to 6 or 8 weeks, while internal medicine and surgery remain at 8.  I also have found that there are fewer pediatricians involved in the pre-clerkship curriculum, fewer pediatricians who serve as mentors and role models for students, and fewer pediatricians who serve in leadership roles such as Vice Chairs of Education.  At a recent COMSEP meeting, Dr. Robin English, Associate Dean of Student Affairs at the LSU Health School of Medicine, remarked that curriculum deans must balance demand for content with a limited number of weeks of curricular time; they cannot then focus on the pediatric or primary care workforce issues.  The Pediatrics 2025 AMSPDC Workforce Initiative challenged educators to change the educational paradigm and focus on attracting diverse trainees into pediatrics (15).  Given the impending workforce crisis, I argue that this is imperative for the longevity of pediatrics that medical schools intentionally work work   to increase the amount of exposure medical students get to Pediatrics.

    So, what do you think?  Am I crazy and just bitter because I am a pediatrician?  Or are medical schools unintentionally biased against pediatrics (and primary care)?  Can (or even should) Medical Schools work to alter the trajectory of the Pediatric (and Primary Care) Workforce Crisis?

    Let’s discuss….

    1. Are medical schools unintentionally biased against pediatrics and primary care? Why or why not?
    2. Can (or should) medical schools actively encourage or incentivize more students to enter pediatrics (or primary care) by offering early and meaningful exposure?
    3. What does your institution do to expose more students to pediatrics (or primary care). If they don’t, what initiatives/efforts could they do?
    4. Do you think initiatives like tuition free medical schools, creation of primary care tracks, or regional campus medical schools can help to increase the number of students entering pediatrics/primary care? Why or why not?

    References

    1. Committee on Pediatric Workforce, Basco, W. T., Rimsza, M. E., Rimsza, M. E., Hotaling, A. J., Sigrest, T. D., & Simon, F. A. (2013). Pediatrician workforce policy statement. Pediatrics, 132(2), 390-397.
    2. https://publications.aap.org/aapnews/news/28441/Pediatrics-fill-rate-dips-during-2024-Match-AAP (accessed June 27, 2025)
    3. https://publications.aap.org/aapnews/news/31676/Pediatrics-marks-milestone-in-2025-Match-with?autologincheck=redirected (accessed June 27, 2025)
    4. Chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.aafp.org/dam/AAFP/documents/medical_education_residency/the_match/AAFP-2024-Match-Results-for-Family-Medicine.pdf?utm_medium=email&utm_source=transaction. (accessed June 27, 2025).
    5. Hanson, Melanie. “Average Medical School Debt” EducationData.org, Updated August 28, 2024.  (accessed June 27, 2025). https://educationdata.org/average-medical-school-debt
    6. https://weatherbyhealthcare.com/blog/pediatrician-salary-2024 (accessed June 27, 2025).
    7. https://www.medscape.com/slideshow/2024-compensation-pediatrician-6017149 (accessed June 27, 2025).
    8.  Azok, J. G., O’Donnell, K. A., Long, M. E., Wang, H. C., Crook, T., Pogemiller, M. I., … & Weinstein, A. R. (2024). Factors influencing medical students’ career choice to pursue pediatrics. The Journal of pediatrics, 265.
    9. Wiedermann, C. J. (2023, June). Revitalizing general practice: the critical role of medical schools in addressing the primary care physician shortage. In Healthcare (Vol. 11, No. 13, p. 1820). MDPI.
    10. Seehusen, D., Raleigh, M., Phillips, J., Prunuske, J., Morley, C., Polverento, M., … & Wendling, A. (2022). Institutional characteristics influencing medical student selection of primary care careers: a narrative review and synthesis. Family medicine, 54(7), 522-530.
    11. Holmes, D., Tumiel-Berhalter, L. M., Zayas, L. E., & Walkins, R. (2008). ” Bashing” of medical specialties: students’ experiences and recommendations. Family medicine, 40(6), 400.
    12. Weinstein, A., MacPherson, P., Schmidt, S., Van Opstal, E., Chou, E., Pogemiller, M., … & Held, M. (2023). Needs assessment for enhancing pediatric clerkship readiness. BMC medical education, 23(1), 188.
    13. Guiot, A. B., Baker, R. C., & Dewitt, T. G. (2013). When and how pediatric history and physical diagnosis are taught in medical school: a survey of pediatric clerkship directors. Hospital Pediatrics, 3(2), 139-143.
    14. Held, M. R., Gibbs, K., Lewin, L. O., & Weinstein, A. R. (2017). Do pre-clinical experiences adequately prepare students for their pediatrics clerkship: a needs assessment to inform curricular development. Medical Science Educator, 27(3), 515-521.
    15. Vinci, R. J., Degnon, L., & Devaskar, S. U. (2021). Pediatrics 2025: the AMSPDC workforce initiative. The Journal of pediatrics, 237, 5-8.

    Author: Chris Peltier, M.D.; Council on Medical Student Education in Pediatrics

  • Uncategorized

    Teaching Tomorrow’s Doctors: Why AI Belongs in the Medical Curriculum Today

    [This blog entry was created using AI tools as part of an exploratory process. The initial step involved identifying relevant articles using Open Evidence (OpenEvidence). After filtering the results, the writer selected the four most salient articles for deeper analysis. These were then input into ChatGPT with instructions to generate a 500-word blog post tailored to an audience of medical educators across disciplines. Several rounds of revisions followed, involving both AI-assisted editing and human review, including careful cross-checking of references. This process illustrates one example of how leveraging the strengths of various AI tools can enhance academic and professional communication.]

    Artificial intelligence (AI) isn’t coming to healthcare—it’s already here. From diagnostic support to personalized treatment planning, AI is reshaping how clinicians work. Yet, as the tools grow smarter, are we making sure our future doctors are ready to use them wisely?

    For many medical schools, integrating AI into the curriculum still feels like a futuristic challenge, reserved for tech-forward institutions or students with a coding background. But that mindset may be doing our learners—and their future patients—a disservice.

    As Lee et al. (2021) noted in their scoping review, most current efforts to teach AI in undergraduate medical education are fragmented and inconsistent. Students get glimpses of AI—perhaps in a radiology elective or a data science lecture—but rarely develop a foundational understanding of how it fits into clinical reasoning, ethical decision-making, or patient care.

    Fortunately, the conversation is shifting. Gordon et al. (2024), in their comprehensive BEME review, advocate for a structured, competency-based approach to AI education. Rather than teaching “about technology,” they propose helping students become critical consumers of AI—able to evaluate algorithms, question biases, and make informed clinical choices in AI-augmented environments. 

    What should this look like in practice? Çalışkan et al. (2022) provide a helpful starting point. Through a Delphi study, they identified core competencies that medical students should acquire, including data literacy, understanding the limitations of AI, and ethical awareness. These aren’t just technical skills—they’re critical thinking tools.

    This shift isn’t about turning every med student into a programmer. It’s about preparing them to ask smart questions: Can I trust this algorithm’s output? Is it transparent? Could it reinforce existing healthcare inequities?

    Engaging students in these conversations is not just possible—it’s essential. As Chen et al. (2019) emphasized, students respond well to case-based and clinical examples where AI tools are already in use. Imagine a cardiology module that includes AI-based EKG interpretation, or an ethics seminar that tackles algorithmic bias in patient triage.

    Wartman and Combs (2018) take it a step further, arguing that AI should catalyze a reimagining of medical education itself. In a world where machines can recall every clinical guideline, the value of a physician lies in synthesis, judgment, and humanity. Our curricula and means of evaluation should evolve accordingly.

    And AI isn’t just the content—it can also be the method. Tools that offer AI-powered feedback (Aquifer, 2025) or assist in curriculum mapping (Raskob et al., 2025) are already helping educators personalize learning and identify gaps.

    Medical educators don’t need to become data scientists—but we do need to lead this transformation. Let’s give our students the tools to engage with AI thoughtfully, challenge it where needed, and use it to deliver more equitable, effective care. Because the future of medicine isn’t just high-tech—it’s human-led, AI-enabled.

    What do you think?

    1. Where in your current curriculum could AI naturally be introduced or integrated?
      Think about existing modules (e.g., radiology, pathology, ethics) where AI tools are already being used in clinical practice.
    2. What competencies do you think are most important for students to develop regarding AI in medicine?
      How might you prioritize ethical reasoning, data literacy, or critical evaluation of AI tools?
    3. How prepared do you feel—individually or institutionally—to teach about AI in medical education?
      What support, training, or partnerships would help you feel more confident?
    4. How can AI be used not just as content, but as a tool for teaching and assessment in your program?
      Have you considered ways to use AI for formative feedback, curriculum mapping, or adaptive learning?
    5. What potential risks or unintended consequences should we be mindful of as we integrate AI into medical education?
      How do we ensure equity, transparency, and student-centered learning while adopting new technologies?

    References

    Aquifer (2025). AI-Powered Feedback: Enhancing Clinical Reasoning in Medical Education. Available at https://aquifer.org/blog/ai-powered-feedback-enhancing-clinical-reasoning-in-medical-education/. Accessed June 17, 2025.

    Çalışkan, S. A., Demir, K., & Karaca, O. (2022). Artificial intelligence in medical education curriculum: An e-Delphi study for competencies. PLOS ONE, 17(7), e0271872. https://doi.org/10.1371/journal.pone.0271872

    Chen, J. H., Asch, S. M., & Wren, S. M. (2019). Artificial intelligence in medical education: A review. JMIR Medical Education, 5(1), e13930. https://doi.org/10.2196/13930

    Gordon, M., Daniel, M., Ajiboye, A., Atkinson, H., Downer, J., & Parise, A. (2024). A scoping review of artificial intelligence in medical education: BEME Guide No. 84. Medical Teacher, 46(4), 446–470. https://doi.org/10.1080/0142159X.2024.2314198

    Lee, J., Wu, A. S., Li, D., & Kulasegaram, K. M. (2021). Artificial intelligence in undergraduate medical education: A scoping review. Academic Medicine, 96(11S), S62–S70. https://doi.org/10.1097/ACM.0000000000004291

    Raskob, K., Duman, H., Kinder, J., Lee, J., Wilson, J., & Segerson, K. (2025). Twelve tips to harness the power of AI for curriculum mapping. Medical Teacher, 1–10. https://doi.org/10.1080/0142159X.2025.2513427

    Wartman, S. A., & Combs, C. D. (2018). Reimagining medical education in the age of AI. Academic Medicine, 93(8), 1107–1109. https://doi.org/10.1097/ACM.0000000000002111

    Author: Silka Patel, M.D., MPH; Association of Professors of Gynecology and Obstetrics

  • Grading

    Clinical Competency Committees in Undergraduate Medicine

    How do you fairly assess a medical student with discrepant clinical evaluations? Or a medical student with professionalism concerns despite successfully completing all academic and clinical requirements? These are some of the challenges faced by Clerkship Directors when grading students.

    Clinical competency committees (CCC) provide a methodical approach to assessing a medical student’s progress and readiness for the next stage of training. Unlike traditional grading policies that might promote a student who meets minimum criteria within a defined block of time, clinical competency committees evaluate a learner’s mastery of expected milestones (1).

    CCCs have consistently been used in graduate medical education to communicate expectations, standardize evaluation of trainees, identify trainees who are not on a satisfactory trajectory, and develop individualized growth plans (1). Additionally, the CCC encourages a resident to assess their current ability in various competencies, reflect on any gaps, and take accountability for future growth (1). CCCs are a requirement for accreditation of residency and fellowship programs, and the Accreditation Council for Graduate Medical Education (ACGME), has published a comprehensive guidebook for programs to use (2).

    Similar models have been used in undergraduate education (3-5). A national survey administered to internal medicine clerkship directors and conducted by the Alliance of Academic Internal Medicine revealed that 42% of respondents had some form of a grading committee. The grading committees varied considerably in content and purpose; however, they were primarily used to determine the final grade of students at risk for failing, have differing clinical evaluations, and have professionalism issues (6).

    The AAMC Core Entrustable Professional Activities (EPAs) provides a standardized framework to evaluate a medical student’s readiness to enter residency, regardless of specialty. The authors define an “entrusted learner” as one who demonstrates proficiency across 13 defined behaviors without any direct supervision. Although there are similarities, the authors distinguish EPAs from competencies in that EPAs are intended to mirror real-life situations encountered by a physician during their daily workflow. Various competencies and associated milestones are integrated into each activity (7).

    Although CCCs have the advantage of offering a standardized and transparent evaluation process based on expected competencies, there may be several barriers to successful implementation. Clerkships must determine the optimal number of committee members, types of committee members, and frequency of meetings. In addition, committee members must agree on the role of the CCC in determining grades and promoting student self-reflection and growth. Members must develop a shared mental model regarding the impact of variable grading styles used by evaluators when completing clinical evaluations, methods to address discordant data, and strategies to minimize bias (7). Despite these challenges, CCCs offer a promising method for ensuring medical students are on a successful trajectory for advancing to the next level.

    What do you think?

    • Are CCCs the optimal way to evaluate students? What are some of the limitations of this strategy?
    • Does your UME program use a CCC? If so, what were some unexpected hurdles to overcome? Can you recommend some keys to success?
    • Can you think of any examples where a CCC may have provided a different outcome in a student’s evaluation?

    References

    1. Goldhamer MEJ, et al. Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency – Based Time-Variable Advancement. J Gen Intern Med 2022; 37 (9):2280-90.
    2. Andolsek K, et al. Accreditation Council for Graduate Medical Education Clinical Competency Committees: A Guidebook for Programs (3rd ed). https://www.acgme.org/globalassets/acgmeclinicalcompetencycommitteeguidebook.pdf
    3. Monrad SU, et al. Competency Committees in Undergraduate Medical Education: Approaching Tensions Using a Polarity Management Framework. Acad Med 2019;94(12:1865-72. doi:10.1097/ACM.0000000000002816
    4. Murray KE, et al. Crossing the Gap: Using Competency-Based Assessment to Determine Whether Learns are Ready for the Undergraduate – to – Graduate Transition. Acad Med: 2019; 94(3): 338-45 doi:10.1097/ACM.0000000000002535.
    5. Mejicano GC, et al. Describing the Journey and Lessons Learned Implementing a Competency-Based, Time-Variable Undergraduate Medical Education Curriculum. Acad Med 2018;93:S42-S48 doi:10.1097/ACM.0000000000002068.
    6. Alexandraki I, et al. Structures and Processes of Grading Committees in Internal Medicine Clerkships: Results of a National Survey. Acad Med 2025;100 (1), 78-85.
    7.  AAMC Core Entrustable Professional Activities for Entering Residency: Curriculum Developers’ Guide 2014. https://store.aamc.org/downloadable/download/sample/sample_id/63/%20

    Author: Catherine Derber, M.D.; Eastern Virginia Medical School. Organization: Clerkship Directors in Internal Medicine

  • Communication,

    Fragile Snowflakes or Feedback-Starved Learners? Finding the Middle Ground in Medical Education

    Faculty today often feel like they’re walking a tightrope when it comes to giving feedback to medical students. On one hand, students consistently express a desire for more feedback. On the other, their responses (especially to constructive or feedback they deem to be more a criticism) can leave educators feeling demoralized, cautious, or even labeled as “toxic.” This tension often drives educators into what Kim Scott calls “Ruinous Empathy”, where feedback is diluted with niceties, lacking the clarity necessary for growth (1,2). 

    Giving meaningful feedback is an emotional labor. It demands vulnerability, courage, and a strong sense of responsibility. Faculty don’t want to be the villain in a student’s narrative, especially in an era where student well-being is prioritized—rightly so—but sometimes conflated with emotional protection from professional critique, and where “negative” feedback, if it finds itself into the student’s narrative record, can reduce opportunities to match for a residency. Yet Scott reminds us that honest feedback doesn’t have to be cruel. In fact, the hallmark of “Radical Candor” is the ability to “…challenge directly while caring personally” (1).

    Consider the now-famous anecdote of Sheryl Sandberg giving feedback to Scott after a successful presentation. After offering praise, Sandberg added, “But you said *um* a lot… it makes you sound stupid.” It was blunt—but it came from a place of trust and investment in Scott’s growth (2,3). The lesson is that radical candor is not about brutal honesty. It’s about building relationships where truth and compassion coexist.

    In medical education, we often talk a lot about the importance of feedback. But what’s missing is what has been referred to as feedback literacy, for faculty AND for learners. Students must be taught how to interpret, process, and apply feedback without collapsing into shame or defensiveness, and to expect it as a significant component towards their professional growth. As Indiana Lee (4) argues, empathy in the workplace isn’t about avoiding discomfort—it’s about engaging with it productively. Emotional responses like frustration and hurt are human. But if students are conditioned to view all constructive feedback as a threat, they will lose invaluable opportunities for learning and increased self-awareness.

    Faculty, too, need support in learning how to navigate these moments. Avoiding critical conversations under the guise of being “nice” is not kindness (1,5). Ruinous Empathy not only undermines student development but ultimately erodes trust. As one study cited by Scott noted, mentors and advisors who challenged their mentees while showing care built stronger, more effective relationships, whether in finance, teaching, or leadership (5,6).

    Psychological safety must be the foundation of educational environments (7). That means faculty must both validate student emotions and hold up a mirror to them. Feedback, as Scott reminds us, is simply information. It’s what we do with it that counts (1). By modeling care and candor ourselves, we can foster a culture where feedback is welcomed as a gift rather than feared as judgment. On the student side, the school must establish and foster the perception of psychological safety by the students and create the environment in which the student learn to expect frank feedback and are given tools to accept it as it is offered. 

    Are students ready to receive honest feedback? Not always. But can they learn to be? Absolutely! The school needs to own preparation of the student to receive and synthesize feedback. Individual faculty need to prepare the student for how they communicate feedback.

    And are we, as educators, ready to stop using ruinous empathy as a shield? Because while it may feel like kindness in the moment, avoiding honest feedback ultimately does more harm than good. 

    Let’s stop confusing kindness with comfort. Real kindness is helping someone grow—even when it’s uncomfortable in the moment. In fact, there’s good evidence that discomfort is a path to growth (8).

    • What do you readers think?  How can we address the following questions?
      How might you create a no-nonsense zone in your teaching or clinical environment—where truth is welcomed and compassion is assumed?
    • When was the last time you withheld feedback out of fear? What might have changed if you had used Radical Candor instead?
    • What would it look like to teach students explicitly how to receive feedback as a professional skill?

    References

    1. Scott K. Video Tip: What is Radical Candor? Learn the Basic Principles In 6 Minutes. Available at https://www.radicalcandor.com/blog/what-is-radical-candor/. Accessed on April 18, 2025.
    2. Steiner W. Radical Candor: The Importance of Guidance vs Feedback. 2017. Available at https://executivecoachingconcepts.com/radical-candor/. Accessed on April 18, 2025.
    3. Raso R. Using Radical Candor. Nursing Mgmt 2018; 49(12):5.
    4. Lee I. What Is Empathy In the Workplace? (Not to Be Confused with Ruinous Empathy). 2023. Available at https://www.radicalcandor.com/blog/empathy-in-the-workplace/. Accessed April 18, 2025.
    5. Scott K. Ruinous Empathy Can Wreck Client Relationships. 2021. Available at https://www.radicalcandor.com/blog/ruinous-empathy-client-relationships/. Accessed on April 18, 2025.
    6. Scott K. What is Ruinous Empathy? Available at https://www.radicalcandor.com/faq/what-is-ruinous-empathy/. Accessed on April 18, 2025.
    7. Johnson CE, Keating JL, Molloy EK. Psychological safety in feedback: What does it look like and how can educators work with learners to foster it? Med Educ. 2020 Jun;54(6):559-570.
    8. Wilson B. Discomfort: A Pathway to Growth. 2023. Available at https://www.psychologytoday.com/us/blog/explorations-in-positive-psychology/202307/discomfort-a-pathway-to-growth. Accessed on April 18, 2025.

    Author: Gary L. Beck Dallaghan, Ph.D.; Alliance for Clinical Education

  • Communication

    What Did You Just Say? Fostering Civil Discourse in Medical Education

    Let’s talk about talking.  It seems given the current environment in the U.S., we’re walking on eggshells, not really sure what we can or should say. These challenges with conversing have resulted in a pressure cooker within academic health centers amongst many other places. Stress, long hours, and differing opinions can sometimes lead to terse discourse (1,2). Whether it’s a vigorous debate during rounds, a classroom discussion has gone awry, or a tense exchange between colleagues, communication seems to be broken. The ability to de-escalate conflict and promote respectful conversations is paramount. As medical educators, we must model and cultivate civil discourse to create a positive learning environment and equip future healthcare professionals with essential communication skills.

    Are you still with me?  Good! In Robert Livingston’s book The Conversation (3), he references cognitive heuristics that we use. A heuristic is a tendency to overweight information readily available in your mind when making a decision. As clinicians, illness scripts are a medical application of a cognitive heuristic. You’ve seen many presenting with nearly identical symptoms, so you immediately go to the diagnosis you believe it is. Without additional contrary evidence to sway you, you proceed to treat accordingly (and of course run the risks associated with premature closure).

    Where cognitive heuristics occur in normal discourse, these have been built over time based on an individual’s experiences and knowledge. When confronted, for example, with an initiative related to diversity and inclusion, their heuristics may lead them to believe diversity of thought is a bad thing, something undesirable. Why? Who knows? The reaction may then be the polar opposite of what you expect and will clearly interfere with what you hope to accomplish. This can even occur in simple conversations.

    The bigger question is how can we break this cycle of high-tension communication? How do we gain an understanding and respect of others’ experiences to converse in a civil manner? How can we carry on conversations that seek to find mutual understanding and maintain mutual respect (even if we do not agree)?

    As you can well imagine, there are a lot of approaches described online. When a conversation becomes heated, it’s crucial to act as a calming influence. Here are some techniques to de-escalate:

    • Establish Psychological Safety: Remind everyone that you’re on the same team and want to find a resolution together. Use inclusive language and express a willingness to work through the issue collaboratively.
    • Ask Open-Ended Questions: Encourage reflection and sharing of perspectives. Instead of accusatory questions, try “Can you help me understand your perspective on this?” or “What’s most important to you in this situation?”.

    Finding common ground is essential for moving past conflict and fostering understanding, which is a key premise of Livingston’s book (3). Probably the most important advice offered in several other articles is active listening. Truly listen to understand, not just to respond. You have to avoid the temptation to be contemplating your response when they are speaking. Pay careful attention to the underlying concerns or values being expressed (4,5). Don’t worry if there’s a gap, a brief silence, in a conversation.

    Livingston’s framework for structuring dialogue to promote deeper understanding and collaboration involves asking deliberate, thoughtful questions to elicit information and encourage reflection (3). These are a few that may help:

    • Start with “What Happened?” or “What’s the issue we’re facing?”: Encourage a factual recounting of events or perspectives to establish a shared understanding of the situation.
    • Move to “Feelings”: Ask about the emotions involved: “How did that make you feel?”. Acknowledging feelings can help de-escalate tension and build empathy.
    • Explore “Identity”: Consider how the situation impacts individuals’ sense of self and their role within the group. This can help uncover underlying motivations and perspectives.
    • Examples of Dialogue-Enhancing Questions:
      • “Can you tell me more about how you see it impacting the situation?”
      • “What would a successful resolution look like for you, and how can we work toward that?”
      • “What are some other approaches we could consider here?”

    The house of medicine has to interact with people of varied backgrounds. Although some of those people may not share any of our own values, it is essential to be able to converse with one another in a respectful, caring manner.

    This Med Ed Chat blog is a bit different, but it felt needed in our current environment. Here are some questions for you to consider:

    • How can we, as medical educators, create a culture that encourages open and respectful dialogue, even when discussing contentious issues?
    • What strategies can we implement to ensure that all voices are heard and valued in discussions about diversity, equity, and inclusion?
    • How can we equip future healthcare professionals to navigate and resolve conflicts that arise from differing perspectives and experiences?
    • How can we prepare when someone is intransigent? What might that conversation look like – especially if you’re the intransigent one?

    Thank you for indulging my musings on this topic.

    References:

    1. May H. Create a CULTURE of belonging. HR Future 2022 (6); 46-47.
    2. Medina FJ, Benitez M. Effective behaviors to de-escalate organizational conflicts in the process of escalation. Sp J Psychol 2011; 14(2):789-797.
    3. Livingston R. The Conversation. New York, NY: Currency, 2021.
    4. Del Bel JC. De-escalating workplace aggression. Nurs Mgmt 2003 (9); 30-34.
    5. Albardiaz R. De-escalating emotions: A process. Educ Primary Care 2017; 28(1):54-55.

    Blog Author: Gary L. Beck Dallaghan, Ph.D.; Administrative Director, Alliance for Clinical Education. 

  • Diversity

    Hear Me Out! Inclusion also Includes Deaf and Hard-of-Hearing Medical Students

    Sticking with the theme of our previous MedEdChat blog last month, diversity in the health care workforce in general and undergraduate medical education needs constant attention. Although this is a topic that has been well-researched, one crucial aspect of diversity often remains under-addressed: the inclusion of individuals with disabilities. This blog post explores in general terms why actively training individuals with disabilities is important and specifically focuses on deaf and hard-of-hearing individuals in medicine. 

    In 2018, Meeks and colleagues (1) reported that nearly 20 percent of the US population has a disability. Many of these individuals face healthcare disparities due to a lack of understanding of their challenges by their providers. One example noted that many primary care settings lack appropriate exam tables, weight scales, and restrooms for patients with disabilities (2). Although studies have identified the benefits of a workforce that embraces diverse healthcare providers, relatively few individuals with disabilities work in medicine. Moreso, only 2.7% of medical students disclose disabilities, 10% of which have apparent disabilities and 90% do not (2). 

    To be totally transparent about why this blog focuses on deaf and hard-of-hearing (DHoH) individuals entering medicine, I was a sign language interpreter for nearly 25 years and also have a prominent hearing loss. The most obvious benefit for more DHoH providers in medicine is the ability to communicate directly with patients. As McKee and colleagues (3) also point out, DHoH physicians enrich the medical education experience by fostering greater disability awareness among their peers and faculty. Increased awareness translates to a better understanding of how to interact with and care for DHoH patients and their families, ultimately improving patient care and outcomes (1). Furthermore, DHoH professionals offer unique perspectives and lived experiences that can lead to innovative approaches in UME, patient care and healthcare delivery (3). They can also serve as role models and advocates for their community, fostering greater trust and engagement between healthcare providers and DHoH patients (4).

    Despite the clear benefits, DHoH individuals remain underrepresented in medical schools and the physician workforce (4). This underrepresentation is often attributed to systemic barriers, including biases in application processes, a lack of inclusive educational opportunities, and insufficient accessibility support (5,6). As Meeks et al. (5) note, disability is often an “unexamined diversity,” with many institutions lacking comprehensive policies and practices to support students with disabilities. Although universities provide central disability resources, the unique demands of medical education programs challenge these offices (6).

    Additionally, the Liaison Committee on Medical Education standards stipulate every school has technical standards (7). Even in light of the Americans with Disabilities Act, the Standards are often written in ways that do not take into consideration individuals with disabilities. If a school expects that all students, for example, can use a stethoscope and appreciate rales and murmurs, what accommodations are made for someone with profound hearing loss? If the school expects all students to perform “inspection” as part executing a physical exam, how can one accommodate a blind person?

    The inclusion of DHoH individuals in medicine has far-reaching benefits. It not only improves healthcare access and quality for the DHoH community but also strengthens the medical field as a whole. A diverse physician workforce brings unique perspectives, problem-solving skills, and lived experiences that enhance medical training and research (8). By embracing diversity, the medical field can better reflect the communities it serves and provide more equitable and effective care for all.

    What do readers think? How can we address the following questions?

    1. How does inclusion of DHoH individuals in medical education programs challenge admission and accreditation standards for medical schools? Specifically, are technical standards essential for the practice of medicine truly essential? Can they be modified?
    2. How can medical educators and advisors become better equipped to support students with disabilities in rigorous and fast-paced programs?
    3. What are the potential long-term benefits of having more DHoH doctors in the healthcare workforce for both the medical community and patients?

    Give us your thoughts!

    References

    1. Meeks LM, Herzer K, Jain NR. Removing Barriers and Facilitating Access: Increasing the Number of Physicians With Disabilities. Acad Med. 2018 Apr;93(4):540-543. doi: 10.1097/ACM.0000000000002112.
    2. Mudrick NR, Breslin ML, Liang M, Yee S. Physical accessibility in primary health care settings: results from California on-site reviews. Disabil Health J. 2012 Jul;5(3):159-67. doi: 10.1016/j.dhjo.2012.02.002.
    3. McKee MM, Smith S, Barnett S, Pearson TA. Commentary: What are the benefits of training deaf and hard-of-hearing doctors? Acad Med. 2013 Feb;88(2):158-61. doi: 10.1097/ACM.0b013e31827c0aef.
    4. Moreland CJ, Latimore D, Sen A, Arato N, Zazove P. Deafness among physicians and trainees: a national survey. Acad Med. 2013 Feb;88(2):224-32. doi: 10.1097/ACM.0b013e31827c0d60.
    5. Meeks LM, Case B, Stergiopoulos E, Evans BK, Petersen KH. Structural Barriers to Student Disability Disclosure in US-Allopathic Medical Schools. J Med Educ Curric Dev. 2021 May 26;8:23821205211018696. doi: 10.1177/23821205211018696.
    6. Meeks LM, Case B, Herzer K, Plegue M, Swenor BK. Change in Prevalence of Disabilities and Accommodation Practices Among US Medical Schools, 2016 vs 2019. JAMA. 2019 Nov 26;322(20):2022-2024. doi: 10.1001/jama.2019.15372.
    7. Liaison Committee on Medical Education. Functions and Structure of a Medical School, 2025-26. Available at https://lcme.org/publications/. Accessed February 19, 2025.
    8. Meeks LM, Plegue M, Swenor BK, Moreland CJ, Jain S, Grabowski CJ, Westervelt M, Case B, Eidtson WH, Patwari R, Angoff NR, LeConche J, Temple BM, Poullos P, Sanchez-Guzman M, Coates C, Low C, Henderson MC, Purkiss J, Kim MH. The Performance and Trajectory of Medical Students With Disabilities: Results From a Multisite, Multicohort Study. Acad Med. 2022 Mar 1;97(3):389-397. doi: 10.1097/ACM.0000000000004510.

    Blog Author: Gary L. Beck Dallaghan, Ph.D.; Administrative Director, Alliance for Clinical Education. 

     

    Blog Response – February 19, 2025:

    1. How does inclusion of DHoH individuals in medical education programs challenge admission and accreditation standards for medical schools? Specifically, are technical standards essential for the practice of medicine truly essential? Can they be modified?

    Yes, technical standards are essential and important; however, they must be written so they are not exclusionary.  For example, instead of using the sensory words like “hear” and “see” the tech standards should say “communicate” or “observe”; in other words, the TS should say what needs to be accomplished without stating how the task should be accomplished.  Also include that TS can be accomplished with accommodations when the accommodations do not equal a fundamental alteration. 

    1. How can medical educators and advisors become better equipped to support students with disabilities in rigorous and fast-paced programs?

    Partner with your disability services office; attend disability related professional development sessions/workshops; invite experts (including disabled students) to speak to faculty and staff.  Invite in doctors with disabilities to speak about strategies that were important for them to progress through med ed. 

    1. What are the potential long-term benefits of having more DHoH doctors in the healthcare workforce for both the medical community and patients?

    Understanding a person’s lived experiences is important to provide the best possible care.  Having lived those or similar experiences gives a doctor an advantage in treating patients by allowing a level of knowledge others without such experiences may not have.  As human beings live longer, the population of those with hearing loss will continue to grow.  The long term positive impact of D/d/HH doctors is essential to address the needs of these individuals. 

    Note:  “D” is for those who  consider deafness their culture and don’t consider themselves disabled.  “d” is those who are deaf, but don’t consider deafness their culture.  HH is hard of hearing.  Important terminology to include when speaking about these populations.

    Cindy Poore-Pariseau, Ph.D.; Director, Office of Disability Services, Rutgers Health