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  • Workforce

    Are Medical School 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

  • Diversity

    Diversity and Inclusion in #MedEd

    Medical education is facing many serious challenges. Specific to diversity, equity and inclusion (DEI), as some states are passing legislation limiting discussions related to DEI, attempts to educate medical students about the spectrum of patients they may see faces scrutiny. What has caused this backlash towards DEI initiatives? 

    As a key aspect of helping students develop (or enhance) their cultural humility, DEI programs encompass broad concepts aimed at fostering inclusive environments where all individuals feel respected and valued. Diversity encompasses representation of different identities and backgrounds, including race, gender, ethnicity, age, and more. However, diversity is not limited to ethnic or racial groups but extends to all aspects of individual identity and experience [1,2]. Equity is the process of ensuring fair treatment, access, and opportunities by acknowledging and addressing systemic disparities that disadvantage certain groups [Coulter et al]. Inclusion is the practice of creating environments where diverse individuals are fully integrated and empowered to participate. In healthcare education, for instance, DEI principles are integral for promoting culturally responsive care [3].

    Evidence does, however, suggest that overly narrow definitions of DEI can inadvertently lead to exclusion. One major criticism is that focusing on specific groups can consequently neglect other marginalized communities, such as those with disabilities, those from low socioeconomic backgrounds, or sexual and gender minorities [1,2]. For example, in educational settings, when curricula focus on race but fail to integrate discussions on class or gender, certain students may feel marginalized or excluded from the conversation. This limitation is a reminder that inclusivity must be intersectional and address the diversity within groups. The very definition of intersectionality recognizes the interconnectedness of social categories, such as race, disability, gender, socioeconomic background, etc.

    There is also concern that DEI efforts can sometimes unintentionally reinforce stereotypes, particularly when diversity is taught as static characteristics of groups rather than acknowledging the dynamic nature of individual identities [2]. This may lead to historically majority groups feeling excluded and unwelcome in conversations [4].

    Research suggests that well-designed DEI initiatives positively impact learning environments by enhancing cultural competence, reducing bias, and preparing students for diverse patient populations. Studies indicate that the integration of anti-racism education in medical curricula leads to increased student awareness of health inequities and promote critical thinking about the social determinants of health [5,6]. Students who undergo such training are more likely to recognize their innate biases and demonstrate greater empathy in patient care [1,3]. 

    However, DEI initiatives currently face resistance in municipalities, states and even the Federal government. The attacks on DEI impact the learning environment where students feel defensive or disengaged [6,7]. Ultimately this resistance may result in even worse patient outcomes due to inadequate training.  

    To truly foster an inclusive learning or work environment, institutions must promote dialogue that brings together contrasting viewpoints in a psychologically safe setting, maintaining respect and empathy. One strategy is to create safe spaces for open discussions, where students and faculty can critically reflect on their biases without fear of judgment. For instance, some studies have shown that integrating cultural humility and critical consciousness frameworks into curricula encourages lifelong learning and introspection [3,8].

    Additionally, engaging diverse stakeholders, including students, faculty, and community members, can ensure that multiple perspectives are considered when designing DEI initiatives [4,6]. Continuous faculty development is also critical for ensuring that educators have the skills and confidence to address complex social issues in the classroom [7]. Embedding DEI principles throughout the curriculum, rather than treating them as stand-alone add-ons, helps normalize discussions around diversity and equity in everyday practice [2].

    DEI, when implemented thoughtfully, has the potential to transform learning environments by promoting inclusion, reducing bias, and fostering a culture of empathy. However, for DEI initiatives to be truly inclusive, they must be intersectional and comprehensive, addressing the needs of ALL groups while ensuring that no one feels excluded. Ongoing reflection, stakeholder engagement, and faculty development are critical to ensuring these initiatives have a lasting and positive impact on the learning and work environment.

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

    1. How can medical education strike a balance between promoting inclusive environments through DEI initiatives while ensuring that NO groups feel alienated in the process?
    2. As DEI initiatives face increasing resistance due to political and cultural shifts, what strategies should medical educators adopt to create open, respectful dialogue on DEI issues without violating institutional or state restrictions?

    References

    1. Coulter E, McQueen C, Abu-Jurji Z, Chan-Emery I, Rukavina M, Solecki R, Wojkowski S, Dhir J. Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: A scoping review: BEME Guide No. 88. Med Teach 2024:1-13. doi: 10.1080/0142159X.2024.2387147.
    2. Dogra N, Reitmanova S, Carter-Pokras O. Twelve tips for teaching diversity and embedding it in the medical curriculum. Med Teach 2009; 31(11):990-993. doi: 10.3109/01421590902960326. 
    3. Van Liew JR, Lai C, Streyffeler L. Twelve tips for teaching culturally and socially responsive care to medical students. Med Teach 2024; 46(10):1278-1283. doi: 10.1080/0142159X.2024.2322713.
    4. Livingston R. The Conversation: How Seeking and Speaking the Truth about Racism Can Radically Transform Individuals and Organizations. New York: Currency, 2021.
    5. Nathan AS, Del Campo D, Garg PS. Where are we now? Evaluating the one year impact of an anti-racism curriculum review. Med Teach 2024:1-6. doi: 10.1080/0142159X.2024.2316852.
    6. Binda DD, Kraus A, Gariépy-Assal L, Tang B, Wade CG, Olveczky DD, Molina RL. Anti-racism curricula in undergraduate medical education: A scoping review. Med Teach 2024:1-11. doi: 10.1080/0142159X.2024.2322136.
    7. Racic M, Roche-Miranda MI, Fatahi G. Twelve tips for implementing and teaching anti-racism curriculum in medical education. Med Teach 2023;45(8):816-821. doi: 10.1080/0142159X.2023.2206534. 
    8. Dogra N, Bhatti F, Ertubey C, Kelly M, Rowlands A, Singh D, Turner M. Teaching diversity to medical undergraduates: Curriculum development, delivery and assessment. AMEE GUIDE No. 103. Med Teach 2016; 38(4):323-37. doi: 10.3109/0142159X.2015.1105944. 

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