FAQ

Pre-Deployment Considerations

What should I have in place before beginning this program?

Change can be threatening, particularly when you are talking about issues of identity and bias. Therefore, before you begin, you should identify a prominent clinical champion who will publicly reinforce that this program is important and necessary. If you are presenting at M&M, we also suggest making sure you have buy-in from the people who normally conduct the conference. Sitting down face-to-face to go over the curriculum will prevent anyone from feeling blindsided.

Do I need to do any additional research before starting this curriculum?

The curriculum is designed to be used with no additional preparation: each module comes with an exact script, a list of references and additional reading lists. That being said, in order to facilitate discussion, and answer questions regarding the data presented, additional reading may be helpful. The Research and Resources tab contains links to all of the studies references throughout the curriculum as well as links to videos or podcasts that may provide additional information.

What is the difference between the patient-centered and the provider-centered tracks?

The didactic portions are largely the same, the main differences are in the the focus of the sample cases. However, there are some modules that only exist in one track: for example, the weight bias and ableism modules are only in the patient-centered track, and the sexual harassment module only focuses on the provider experience.

Can we switch between the patient-centered and provider-centered tracks?

Absolutely! We encourage each department to select the content that best fits theirs needs. However, if you suspect that you may face some resistance in implementing the curriculum, starting with the patient-centered track may be the best strategy because it more closely mirrors traditional M&M.

Do I need to administer all of the curriculum, or follow the exact order?

No. The curriculum is designed to start with foundational concepts/terminology and build on those concepts once a shared knowledge base is established, but each department is unique and has different needs. If your target audience is well-versed in certain areas feel free to focus on the areas with the most growth potential. Based on the time some departments have allocated, some elect to administer the curriculum every other month, or go through multiple modules in a single session. At the end of the day, do what works for your audience.

Is this program just for surgeons?

Because the curriculum was developed with surgeons in mind, some of the data (such as national promotion or salary statistics) presented in later modules is directed more toward a surgical audience. However, the curriculum draws from data across medical specialties and across fields (business, psychology, social science) so we anticipate the core points will be broadly applicable. Moreover, the slides are editable so presenters can substitute data if they choose.

What do I do if I face resistance to implementing this curriculum?

Paradoxically, institutions or departments that need this curriculum most, may be those that are most resistant to its implementation. Given that this curriculum deviates from traditional M&M in both the types of cases and the content delivery, some may feel that it doesn’t below in M&M time slot. We have found that meeting with members of our community who were more resistant to adoption to delineate their exact concerns was helpful. Additionally, the curriculum is not meant to be static: presenters can adapt it to better meet the needs of the audience to better address individual’s concerns.

Selecting a Forum

Why is this curriculum being presented at M&M?

Our contention is that culture is an integral part of proving superlative patient care. Poor safety culture has been implicated in failure to rescue, while identity-based differences in clinical decision-making/outcomes are seen in everything from trauma care to cardiac catheterization. Furthermore, if systematic identity-based differences exist in how we foster and promote physicians, we are not going to have a workforce that will be able to best meet the diverse scientific and clinical challenges of our time. Thus, understanding the forces that may precipitate disparities is critical to prevent these unintended consequences. We believe that M&M is a particularly powerful format because it is longitudinal, its format and structure are well-established, and group discussion can establish awareness and best practices. Furthermore, it is one of the few settings in the hospital environment where attendings and trainees are together and can build consensus as a group.  

What if I can’t get access to time at M&M?

We recognize that there are many competing demands for time in modern medicine, so at some point, you may need at accept whatever time is accessible. However, when it comes to DEI initiatives, medical students and residents are sometimes more well-versed in the language and science than their senior colleagues. Thus we would encourage anyone looking to deploy the curriculum not to focus purely on leaners even though their time may be most accessible, and instead look for forums where multiple levels of the hierarchy are represented.

Content Delivery

Who should present the curriculum?

Presenters have varied across the pilot sites. If you suspect that the program may face a fair amount of skepticism at your site, enlisting a more senior member of your department to either introduce the curriculum or lead the first module, may be a good starting strategy. That being said, a presenter cohort made up of people of different genders, ethnicities, rank, and age may be beneficial as it will reinforce the idea that no single group perpetuates these issues nor is one group immune. Each module comes with complete slide notes and is thus designed to require no background or formal training in each topic.

How long does it take to deliver each module?

The data portion of each module typically lasts between 5-10 minutes, and can be followed by as much discussion as your session allows. At both pilot sites, the curriculum has been presented as the third M&M of conference and generally lasts about 20 minutes total.

How do you ensure there is useful discussion?

For the first few sessions, while the audience is still getting comfortable with the format, we recommend letting a few participants know what the sample cases are ahead of time so they can jumpstart the discussion. This is not intended to produce canned responses, or coach people to say what we want, but rather to help others feel comfortable talking about the topic in public. It may also be helpful to designate someone to play the devil’s advocate—that is to give voice to an opinion that audience members may have, but worry is too unpopular or “un-pc” to actually say-that way you can address some of the thornier concerns without creating an adversarial environment.

This discussion brought up some painful experiences for me or my colleagues, but we are expected return to clinical duties immediately after, how can we improve the transition?

This is one of the biggest challenges of the curriculum, and the best answer is still evolving. Identifying members of the department who are willing to continue the discussion offline or after hours ahead of time can be helpful. Orchestrating voluntary discussion groups that can delve into thorny topics in more depth is another strategy. Finally, familiarizing yourself with institutional resources such as free or subsidized counseling, Employee Assistance Programs, and harassment policies can also be helpful.

There are multiple sample cases for each module, how do I select which ones to discuss?

The sample cases are designed to be flexible, so you can select scenarios that best match the concerns of your institution. For example, at one of the pilot sites, some audience members wanted to focus more on the patient-physician interactions more than the physician-physician interactions, so cases were selected to speak to that dynamic. Additionally, to make it as realistic as possible we also invite audience members to submit cultural complications they have experienced to discuss at future sessions.

How were studies selected for inclusion in the curriculum?

As possible, studies were selected based on high citation rates on Web of Science, with the rationale that this represented the most impactful science in each area. However, given our aim to present our content in a succinct manner, where multiple studies were available, we choose figures that were rapidly interpretable by an audience that may not have an advanced statistical or epidemiologic background (e.g. we may select bar graph depictions over tables cataloging multivariable regression coefficients). Citations and additional reading lists are supplied throughout.  

Can we do this via zoom?

Yes, in fact the zoom platform offers many advantages. Although it may require some moderator finesse, anonymous chat functions may allow audience members to ask questions that they were uncomfortable asking in person. Chat functions also often flatten the hierarchy and allow people across the department to offer solutions. Poling functions can also help departmental leadership understand how widespread certain cultural complications may be. On the other hand, getting group discussion started may be a bit harder virtually, so identifying people who are willing to speak up a priori may be even more essential.

Participating in Research

What is the research aim?

With this work, we hope to better understand the current health care work force’s attitudes toward Diversity, Equity, & Inclusion (DEI) training and to perform ongoing evaluation to make sure our curriculum meets those needs in a way that is efficient and effective. To the best of our ability, we also aim to keep the administrative/survey burden low for both site organizers and participants. To this end, the we ask interested sites to administer a pretest, survey a subset of the modules, and identify a point person who can provide some contextual data about your specific site (audience composition, demographics of institution etc.)

Why should I (or my institution) participate in research?

Our first aim is to use our findings to help interested departments make the case that this kind or work is necessary, and to refine our curriculum to best meet users’ needs. We also believe that this is a high value product, and to continue to keep it open access, we want to ensure it generates academic value.

What does participation entail?

Step 1: Identify a point person who will help can introduce the research arm, encourage people to participate, and provide institutional information (complete an administrator survey)

Step 2: Select a Survey Group (and communicate your selection to the CC team)

Step 3: Encourage audience members to complete surveys

What are the Groups? How Do I pick one?

In order to limit survey burden, but still make sure that all of the modules are assess, we have divided the study population into thirds. Group A will administer the surveys at the end of modules 1, 4, 7, 10; Group B will administer at the end of 2, 5, 8, 11 and Group C after 3, 6, 9, 12. If yu have a strong preference, you may ask to select a specific group, otherwise we may assign them to make sure the evaluation is balanced.

How do I actually administer the surveys?

There are QR codes embedded at the end of the modules which participants can scan to bring them directly to the survey on their mobile device.

After I select a group, do I have to remember which modules I have to administer surveys for?

No! Our ShareDrive has distinct folders corresponding to the select group, so if you download the modules for Group A, the slides will only have QR codes after modules 1, 4, 7, and 10 so you won’t have to remember which modules needs surveys and which do not.

My institution is not planning on administering the full curriculum, can we still participate in research?

Yes! It would be helpful to us for everyone to take the pretest. However, if you are only planning on administering a few modules, we ask that you download the curriculum from the “Full Curriculum” folder in our ShareDrive. Every module in this folder has a QR code at the end that will link to the survey, that was we can survey whatever subset you choose to administer.

We have already started the curriculum, is it too late to participate?

Ideally, the pre-test will be completed before the first session, but we will accept responses up until your department has completed 1/4 of the curriculum (that is if you have administered 3 or fewer modules.

Can we have access to our institutional data?

Our research has been designated exempt by the Maryland IRB (HP-00085915). We have been told by the IRB that because we are collecting demographic data from contexts that are often quite homogenous, that sharing institution-specific data will potentiate de-identification. However, we are able to share pooled data from similar regions and institutions, which can be found under the “Data” section on the banner above

My leadership wants access to our specific data so that we can demonstrate progress, can you provide this?

We want to be very cautious in how we present the utility of this curriculum. Historically, assessing culture has been extraordinarily fraught: existing survey materials often assess a single point in time, do not account for the multiple different environmental contexts in which health care workers operate, do not account for intersectional experiences, etc. Without a reliable baseline, it is difficult to assess progress. With this in mind, our research focuses mainly on attitudes or process outcomes (do the cases seem realistic? do you believe the data presented? do you feel comfortable discussing the cases in this format?). Thus, we do not recommend using the research arm to measure departmental progress.

Administrative Concerns

I requested the curriculum through your website, but haven’t received anything

We provide a link to the curriculum via a gmail account (either one of the study team' member’s personal accounts, or the team email) so aggressive hospital filters sometimes block the content and you may want to check your spam folder. In addition, our email traffic is handled mainly by a surgical resident/fellow team so during periods when we get very clinically busy, there may be a delay. If you are concerned about lag time or fear that you have been missed please don’t hesitate to re-send the request and we will do our very bets to respond in a timely fashion.

Since hearing about the curriculum, other departments at the institution are interested in using it, can I share?

We want the curriculum to be accessible to anyone who wants to use it, but it’s helpful for our research and tracking purposes if interested parties request it via our website rather than sharing the PowerPoints at the individual-level.

I’m not seeing a script for the PowerPoints

You may need to download the PowerPoint to see the script, it doesn’t always show up on the online preview window