Faculty Bibliography

INTRODUCTION/BACKGROUND:Implicit bias contributes to health care disparities. Addressing implicit bias is one focus of health professions education and learners desire instruction in the topic. Few faculties received skills-based instruction in addressing implicit bias during their own education and training and often feel ill-equipped to facilitate this instruction. Recognizing faculty are both learners and teachers in addressing implicit bias, the authors developed a longitudinal faculty development program informed by the implicit bias recognition and management (IBRM) framework. METHODS:The program, IBRM for Faculty (IBRM4Fac), comprised 8 sixty-minute sessions delivered virtually from November 2020 to March 2021 at an academic safety-net health system. Program goals were skills development, including restoring rapport with patients, debriefing biased encounters, and addressing bias from patients. An external expert in IBRM led each session; materials included slides, worksheets to guide skills-development, and an audience response system. The mixed-methods program evaluation used preprogram/postprogram surveys. RESULTS:Approximately 50 faculty primarily from the department of medicine were invited to participate in the program, N = 17 (34%) participated. Significant improvements occurred in 9/10 surveyed domains of IBRM (P < .05). Narrative responses analyzed through reflexive thematic analysis yielded three themes: (1) Personal strategy development; (2) Personal obstacles to sustained organizational change; and (3) Systemic barriers to sustained organizational change. DISCUSSION/CONCLUSIONS:IBRM4Fac enhanced faculty confidence in addressing implicit bias, and helped faculty overcome identified challenges to implement strategies for teaching, role-modeling, and systems change in addressing implicit bias. Despite a small sample, our program could inform faculty development in addressing implicit bias in clinical and teaching encounters.

INTRODUCTION/BACKGROUND:The aims of this study were to evaluate the decision to extract or treat a tooth with initial root canal therapy (RCT) made by general dentists practicing in the United States; and evaluate the effect of clinical and non-clinical factors on decision-making. METHODS:Authors conducted a cross-sectional survey study. Participants read a clinical vignette presenting a questionably restorable tooth for consideration and provided their clinical recommendations. The primary treatment decision was analyzed as a binary variable: extraction or RCT. Other questions about clinical decision-making used the Likert-scale for capturing responses. Clinician related variables were evaluated: age, gender, years of experience, primary practice setting, and participation with payment systems. Kruskal-Wallis tests were used to compare the treatment decision with Likert-scale responses for clinical decision-making. A logistic regression model investigated the effect of clinician factors on the treatment decision. RESULTS:113 eligible dentists completed the survey. For the presented case, a maxillary first molar, 54% of general dentists recommended initial RCT and 46% recommended extraction. 37.2% of dentists responded that the patient's tooth was somewhat or very likely restorable. None of the evaluated clinician factors were statistically significant in predicting the treatment decision. Borderline significance (p=0.05) was noted for general dentists primarily practicing in academic settings; they had 3.57 times the odds of recommending tooth extraction than dentists primarily in private practice (p=0.05). CONCLUSIONS:This study found that general dentists' decision to either save a tooth with initial root canal therapy or extract was primarily associated with perceived tooth restorability.

Mistreatment of trainees in graduate medical education (GME) persists despite Accreditation College of Graduate Medical Education (ACGME) standards. Mistreatment disproportionately affects minoritized trainees and undermines their well-being and abilities to provide empathic patient care. The authors conducted a scoping review to identify existing structures-education/trainings and programs/policies-to mitigate harm from and address perpetrators of mistreatment, and to map gaps to guide practice and research. They searched PubMed and Embase for US-based, English-language studies (January 2015-July 2025). References were screened independently and in duplicate. Included studies described educational/training interventions or programs/policies, or proposed a structural approach focused on addressing mistreatment of trainees. Of 856 records, 71 studies (41 articles, 30 abstracts) were included: 56 education/trainings and 15 programs/policies. Trainings reached 3909 learners, were predominantly single-session, and commonly used case-based discussion, role-play, and simulation. Assessments relied largely on immediate self-report of knowledge, skills, or attitudes; few used objective measures or longitudinal follow-up. Programs and policies encompassed real-time reporting tools, communication campaigns, co-created protocols, and task forces all focused on addressing mistreatment after the fact. Outcomes included increased reporting volume of mistreatment, characterization of perpetrators, and identification of concentrated areas of mistreatment within the health system, trainee perceptions, and feedback loops. Mapping of the literature revealed many education/training interventions and fewer programs/policies. A significant gap remains because too strong a focus exists on teaching trainees-the targets of mistreatment-to manage the mistreatment after the fact, rather than implementing trainings and programs to proactively prevent learner mistreatment. The authors suggest opportunities including perpetrator-focused, non-punitive trainings, longitudinal skills reinforcement in the clinical learning environment, transparent measurement, and a continuous quality improvement approach to both preventing and recovering from mistreatment. Addressing mistreatment will require institutional policies and comprehensive, equity-informed structures with objective assessment, shifting focus from resilience after harm to prevention at its source.

IMPORTANCE/UNASSIGNED:Limited research exists on sex, racial, and ethnic disparities in required graduate medical education (GME) resident competency ratings across specialties during sensitive periods when career decision-making occurs. Rating disparities using an antideficit-based approach measured by exceptionally high ratings are underexplored in GME. OBJECTIVE/UNASSIGNED:To assess the association of exceptionally high ratings in the Accreditation Council for Graduate Medical Education (ACGME) Milestones during time-sensitive training periods across specialties with differences among residents' characteristics, including sex, race, and ethnicity. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional analysis was conducted between March 15 and December 31, 2025, using 2018 to 2021 Association of American Medical Colleges and ACGME data. Postgraduate year (PGY) 2 residents training at US ACGME-accredited emergency medicine, family medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery residency programs between 2018 and 2021 who self-reported sex, race, or ethnicity were studied. EXPOSURE/UNASSIGNED:Required Milestones ratings at the end of PGY-2 training associated with resident sex and race or ethnicity (underrepresented in medicine [URiM] and Asian), while controlling for preresidency Step 2 Clinical Knowledge examination scores. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Proportion and adjusted odds ratios (AORs) for exceptionally high resident-level ratings (80th percentile level) across competencies in interpersonal and communication skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and systems-based practice. RESULTS/UNASSIGNED:Among 19 492 PGY-2 residents across 1754 programs, 10 384 (53.3%) were female, 28 (0.14%) American Indian or Alaskan Native, 4327 (22.2%) Asian, 1106 (5.7%) Black, 1008 (5.2%) Hispanic or Latinx, 3 (0.02%) Native Hawaiian or Pacific Islander, 12 269 (62.9%) White, 751 (3.9%) reporting 2 or more races, and 3423 (17.6%) classified as URiM. Exceptional rating differences were identified by sex, race, and ethnicity. Across all specialties, female residents had greater odds for 80th percentile ratings (AOR, 1.12; 95% CI, 1.05-1.21; P < .001); whereas when compared with White residents, URiM residents (AOR, 0.68; 95% CI, 0.62-0.76; P < .001) and Asian residents (AOR, 0.67; 95% CI, 0.60-0.74; P < .001) were less likely to have 80th percentile ratings than White residents. Within specialties, URiM residents in emergency medicine, family medicine, internal medicine, obstetrics and gynecology, and surgery were less likely to have 80th percentile ratings, whereas Asian residents in family medicine, internal medicine, pediatrics, and surgery were also less likely than White residents. CONCLUSION AND RELEVANCE/UNASSIGNED:In this cross-sectional national study of residents, exceptionally higher ratings were associated with differing resident characteristics during crucial career planning phases. These results suggest the need for more studies to explore factors of resident success during GME training.

OBJECTIVES/OBJECTIVE:Evidence for the impact of racial implicit bias and clinical reasoning remains conflicting. Our inability to characterize the relationship between racial implicit bias and clinical reasoning (CR) precludes development of comprehensive interventions seeking to address the impact of racial implicit bias on clinical encounters. To address this gap, we conducted a simulation-based investigation with clinical presentations with known health disparities, cognitive stressors common to clinical environments, and Black and White standardized patients (SPs). METHODS:We recruited 75 early-career generalist physicians from five academic medical centers in New York, NY, USA. Physicians engaged in a three-station simulation. The first was for level-setting, familiarizing physicians with the online platform. The second was a diagnostic dilemma - an atypical presentation of acute coronary syndrome (ACS). The third tested treatment decision-making in acute pain. Immediately afterward, physicians completed the Race Implicit Association Test (IAT) and Race Medical Cooperativeness (RMC) IAT measuring affective and cognitive implicit biases, respectively. Two investigators assessed CR accuracy by applying a scoring rubric to physicians' post-encounter notes. RESULTS:Statistical analyses revealed no significant correlations between physicians' Race-IAT scores and CR by SP race. However, for ACS, a moderate correlation was suggested between physicians' RMC-IAT scores and CR accuracy when seeing Black (R=0.36, CI -0.04 to 0.6), but not White, SPs (R=0.1, CI -0.44 to 0.24). CONCLUSIONS:This study expands our understanding of the complex impact of racial implicit bias on clinical encounters. Future, larger studies should explore affective and cognitive implicit biases' effects on CR across varied clinical scenarios and contexts with diverse SPs.

BACKGROUND:Health equity is receiving increased attention in medical education. However, guidance is often lacking on how to integrate health equity into routine medical education. Journal club presents an opportunity to deepen medical educators' and learners' understanding of health equity principles and use it as a lens through which to critically appraise the literature. AIM/OBJECTIVE:We present a health equity framework, iteratively co-created by faculty and learners, that can be applied in a journal club setting. SETTING/METHODS:Academic medical center in New York City, USA. PARTICIPANTS/METHODS:Faculty, residency program directors, medical students, and residents. PROGRAM DESCRIPTION/METHODS:Authors developed the health equity journal club framework during a medical student selective course. Learner and faculty applied the framework to journal club articles; their feedback informed revisions. Framework domains included authorship, ethics, methodology, language, peer review, and references. PROGRAM EVALUATION/RESULTS:Learner evaluations were overall positive, and 86% (n = 13) of responding residency program directors (n = 15) across 15 departments who were surveyed plan to use the framework moving forward. DISCUSSION/CONCLUSIONS:A health equity journal club framework applied to critical appraisal of the literature may facilitate health equity as a routine part of medical education. Co-creating the framework proved vital to inclusion of learner voices.