2021-2022 Innovation Grants Recipients

Becky Blankenburg, Associate Chair of Education and Clinical Professor, Pediatrics Impact of Coaching on Residents’ Sense of Belonging, Inclusion, Wellness, and Professional Identity Formation for Underrepresented and non-Underrepresented in Medicine Residents

Summary

Despite increasing US diversity and evidence that physician diversity improves patient care and enhances educational experience, there remain low numbers of medical trainees and physicians who are underrepresented in medicine (UIM). Coaching has been suggested to improve the retention of UIM individuals. This study aims to understand how individual, longitudinal coaching impacts residents’ sense of belonging, inclusion, wellness, and professional identity formation for UIM vs. non-UIM residents, and to identify effective coaching strategies. METHODS: IRB-approved mixed methods study, using semi-structured individual interviews and surveys of 20-30 UIM and 20-30 non-UIM residents at 5 longitudinal coaching programs. Interview questions will be developed based on Cruess’s professional identity formation conceptual framework. Interviews will be audio-recorded and transcribed verbatim. Following the semi-structured interviews, brief online surveys will assess residents’ sense of belonging, inclusion, wellness, and demographics. ANALYSIS: Data will be analyzed using modified grounded theory, with themes identified through constant comparative approach. Survey data will be analyzed using Wilcoxon Rank Sum Tests and descriptive statistics. PROJECT SIGNIFICANCE: This study will show if and how coaching can be used to improve UIM residents’ sense of belonging, inclusion, wellness, and professional identity formation, with the goal of retaining and supporting UIM trainees.

Proposal

Kevin Chi, Clinical Assistant Professor, Pediatrics & Samantha Wang, Clinical Assistant Professor, Internal Medicine The 5-Minute Moment for Racial Justice: A Multimedia Digital Platform for Identifying and Addressing Racism in Medical Decision Making

Summary

During clinical training, medical students and residents are exposed to racial bias in perpetuated practices and are likely to encounter teachable moments to learn how race affects medical decisions. In the last few years, race-based clinical algorithms and practice guidelines have undergone scrutiny given their potential to propagate race-based health inequities. Examples range from race-driven calculators that may underdiagnosis UTIs in Black children to the overestimation of kidney function in Black adults awaiting kidney transplant. There is an urgent need to challenge status quo with trainees in medicine before they become engrained in practices that perpetuate racial bias. We developed a pilot case-based curriculum called The 5-Minute Moment for Racial Justice (5MMRJ), an innovative anti-racism bedside teaching series that considers the clinical context of a real patient, the current standards of a diagnostic test or treatment paradigm impacted by racial bias, a direct historical example highlighting how the standard contributes to racial disparities, and next steps towards equity. Our goal is to expand and transform the 5MMRJ pilot into an online educational platform to serve as a digital resource for immediate access by educators, learners, and healthcare teams and potentially even shared at the patient’s bedside.

Proposal

Ravi Majeti, Professor, Medicine & Tian Zhang, Assistant Professor, Medicine Improving Intercultural Competencies Utilizing the Intercultural Development Inventory

Summary

The goal of this project is to pilot the use of an Intercultural Development Inventory (IDI) at an individual and group level to assess cross-cultural competency and create action plans to increase inclusivity and equity in academic spaces, such that lab groups may more effectively include and integrate scholars from any cultural background into Stanford’s research environment. This is critical to job performance and well-being, especially for marginalized groups. Specifically, the IDI will be offered to Stanford Medicine lab groups to assess their ability to adapt to and accept different cultural practices. The IDI is an academically established method for determining cultural sensitivity, and accommodating those whose cultural behaviors differ from our own. A certified proctor will interpret the results and create individual and group level action plans. Throughout the academic year, each lab group will execute their action plans and disseminate what they learn to other academic spaces. We will evaluate progress on action items during dedicated quarterly joint meetings and measure quantitative and qualitative changes in lab inclusivity by utilizing the AAMC Diversity Engagement Survey. This proposal addresses three of the Academy Innovation Grant Program’s funding priorities: Collaboration, Diversity and Inclusion, and Impact and Sustainability.

Proposal

Rishi Mediratta, Clinical Assistant Professor, Department of Pediatrics Mobilizing Interdisciplinary Students in the Fight Against Covid-19

Summary

PEDS 220, the Covid-19 Elective, teaches undergraduate, graduate, and professional students about the impact of Covid-19 on society as the pandemic unfolds. There are limited community service and engagement opportunities for students to address problems created by the pandemic. Students from all disciplines are learning about medical and social issues pertinent to Covid-19 while creating projects that address educational and societal problems created by the pandemic through community collaborations. We will evaluate the effectiveness of the mentorship model in PEDS 220 to address community needs, the development of project students’ personal and professional identity and goals, and the sustainability and impact of students’ projects.

Proposal

Kristen Ng, Simulation Fellow, Clinical Instructor, Emergency Medicine, Fellow Reimagining Procedural Competency and Prevention of Skill Decay Using Virtual Reality and Mastery Learning

Summary

Physicians currently lack an efficient method of maintaining procedural competency after initial learning which contributes to skills decay, especially for rare, high-stakes procedures. A means of asynchronous routine retraining is needed to prevent the threats to safety and education that skills decay poses. Mastery learning has been shown to be an effective method of procedural instruction and remediation but has been criticized for its cost in the form of faculty and learning time. Virtual reality (VR) offers a promising solution to the obstacles of expert faculty time and limited-use task trainers in its ability to incorporate adaptive instruction and individualized feedback. As such, we propose the creation of a VR experience capable of delivering asynchronous, simulation-based mastery learning for pericardiocentesis. We will develop a mastery learning checklist for the procedure and an automated instruction script. We will then work with SimX, a healthcare VR company, to develop software to implement this learning experience. We will then evaluate whether VR guided mastery learning is as effective as traditional mastery learning by testing the experience on emergency medicine residents. The outcome will be the number of steps completed according to the mastery learning checklist, as well as a global competency rating.

Proposal

Thomas Pham, Clerkship Director, Surgery Vascular and Endovascular surgery training using 3D printed models

Summary

Knowledge of vascular anatomy and endovascular skill acquisition for medical students is currently mostly limited to two-dimensional means. However, as advanced technologies have been integrated into vascular surgery, it has also established new avenues to educate trainees (medical students, residents, fellows). Specifically, 3D-printing technology can be utilized to teach vascular and endovascular skills, highlight management strategies, and reinforce vascular anatomy. This study will take place during the Surgery Clerkship rotation and survey instruments will be used to evaluate the efficacy of these models into the Vascular Surgery module during this clerkship. Funding requirements for this study include pricing for the development and printing of three 3D-printed endovascular training models (total $1405). Research study personnel include the Surgery Clerkship Director, the Vascular Surgery Program Director, and Surgical Education Research Fellows. Each individual has expertise in curriculum development, skills training, and assessment.

Proposal

Peter Poullos, Clinical Associate Professor, Radiology Mutual Mentorship Program for Persons with Disability in Medicine

Summary

Individuals with disabilities are an underrepresented minority (URM) in medicine due to many obstacles faced in their retention and professional advancement. Disabled clinicians and trainees have few role models or tailored mentorship opportunities to help them navigate their profession. Like other URMs, they require deliberate, specific mentorship that includes: 1) psychosocial support, i.e., empathetic mentoring, a crucial yet often neglected component of mentoring URMs, and 2) instruction to master the “hidden curriculum” in navigating medicine with a disability, which includes knowing one’s rights, when and how to disclose disability status, the process to obtain accommodations, and strategies for self-advocacy. To address these needs, we propose a virtual, mutual mentoring platform in which clinicians at all stages of training engage in online group meetings to network and discuss aspects of the “hidden curriculum.” Importantly, because experience navigating medicine with a disability does not always correlate with stage of training, participants will engage in mutual mentoring, a type of group mentoring in which participants operate as both mentor and mentee simultaneously. This nonhierarchical arrangement promotes skill building, community engagement, knowledge acquisition, cultural competency, sense of belonging, emotional support, feeling valued, accountability, leadership capacity, and problem solving.

Proposal

Jennifer Sedler, Pediatrics, Resident Teaching Pediatric Residents a Communication Framework for Delivering Difficult News: A Randomized-Controlled Trial of Teaching Methods

Summary

Medical trainees are expected to be able to deliver difficult news to patients and their families. This project will create and test a curricular intervention aimed to improve the mastery and self-efficacy of pediatric residents in leading difficult conversations with pediatric patients and their families using evidence-based techniques. Methods and evaluation: The proposed project will be executed in two academic half-day (AHD) segments: a randomized controlled trial AHD to evaluate learner master and self-efficacy of delivering difficult news, followed by a residency-wide AHD series implementing the superior practice strategy. The quantitative data from these pre- and post- self-efficacy surveys and mastery evaluations will be analyzed with Wilcoxon signed-rank tests. We hypothesize that the implementation of this educational intervention will improve resident self-efficacy and mastery by at least 20%, and that RCDP will be a superior practice modality compared to discussion groups. Project significance: Though this will act as a single-institution pilot project, the didactic curricula and simulation scenarios will be designed using advanced multimedia online technology intended to be sustainable for future years as well as accessible to and adaptable for easy use by pediatric programs throughout the country.

Proposal

Paige Stevens, Pediatric Critical Care Medicine, Fellow Design and Validation of Simulation-Based Educational Tools and a Novel Assessment of Spiritual Care Competency (ASCC) Tool for Teaching Spiritual Care Skills

Summary

There is need for a spiritual care curriculum designed to teach pediatric trainees how to address the unique needs of patients and their families in critical care settings. This project aims to design simulation scenarios, training videos, and a novel Assessment of Spiritual Care Competency (ASCC) tool that will be utilized in the implementation and evaluation of a future spiritual care curriculum. Based on Kern’s conceptual model for curriculum development,8 the creation of these educational strategies and the assessment tool is an important step in the design of the future spiritual care curriculum. Faculty collaborators from four tertiary children’s hospitals with experience in medical education and simulation will participate in the creation of the educational tools and assessment tool. Validity evidence for the ASCC tool will be presented according to Messick’s theoretical framework.9 Anticipated work products from this project include three simulation scenarios, nine training videos, and the validated ASCC tool. These tools will then be used in a future study designed to implement and evaluate the efficacy of a spiritual care curriculum for pediatric critical care trainees.

Proposal

Sarah Williams, Clinical Professor, Emergency Medicine & Raina Sanford, Director, Faculty Professional Development, Office of Academic Affairs Scaling Up Coaching: Democratizing Quality Coaching in Medical Education

Summary

We seek an innovation grant to develop a coach training course that will educate and empower faculty to use a coach approach across Stanford's education programs. This grant will support developing the online component of the course. There is ample evidence that coaching enhances performance, motivation, well-being and retention. Dyrbye et al. showed that coaching significantly decreased emotional exhaustion and burnout, while increasing quality of life and resilience among a cohort of physicians in multiple specialties. The American Medical Association’s Accelerating Change in Medical Education Consortium proposes incorporating coaching as a novel intervention to enhance medical education. Yet, most medical educators have not had professional coach training. This course bridges this critical gap, and builds on the successful pilot in Summer 2020 in Emergency Medicine to produce a 2-hour interactive module. This module will serve as a prerequisite for subsequent train-the-trainer courses and could be a standalone CME product. Developing this course has been broadly collaborative across Stanford Medicine; invited collaborators: William Dixon, MD, MSEd, Holly Caretta-Weyer, MD, MHPE, Magali Fassiotto, PhD, Becky Blankenburg, MD, MPH, Carrie Rassbach, MD, Daryl Oakes, MD, Ann Dohn, MS, and Linda Boxer, MD, PhD. The project also meets DEI; impact and sustainability funding priorities.

Proposal

Donna Zulman, Assistant Professor, Department of Medicine, Division of Primary Care and Population Health Presence 5 for Racial Justice – National Virtual Community Advisory Board to Design Online CME

Summary

There is growing recognition that anti-Black racism is embedded in medicine’s structure/curriculum, resulting in suboptimal care for Black patients. Our goal with Presence 5 for Racial Justice (P5RJ) was to inform positive communication strategies for clinicians to best support their Black patients. Collaboration with Black patients and clinicians serving Black communities is essential for the ongoing implementation and dissemination of P5RJ. For this innovation grant, we will partner with clinicians/patients through a virtual National Community Advisory Board (NCAB) to design, develop, and evaluate a P5RJ online CME. The proposed project’s innovative Community-Based Participatory Research approach and our focus on racial justice and anti-racism communication strategies align with TMA priorities of “Collaboration” and “Diversity, Equity, and Inclusion”. Presence 5 for Racial Justice (P5RJ) is a curriculum that aims to promote racial justice and health equity for Black patients. P5RJ trains clinicians in communication practices that address anti-Black racism, build trusting relationships, and empower Black individuals in their clinical care. We aim to: collaboratively design P5RJ online CME course with our National Virtual Community Advisory Board, using CBPR principles; and evaluate using RE-AIM.

Proposal

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2021 - 2022 Innovation Grant Recipients